Healthcare Provider Details

I. General information

NPI: 1487095006
Provider Name (Legal Business Name): AMY VICTORIA DERLIKOWSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 ATLANTIC BLVD
NEPTUNE BEACH FL
32266-4022
US

IV. Provider business mailing address

702 MILITARY RD
BENTON AR
72015-3311
US

V. Phone/Fax

Practice location:
  • Phone: 904-247-1953
  • Fax: 904-247-9390
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD12356
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS53222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: