Healthcare Provider Details

I. General information

NPI: 1023636495
Provider Name (Legal Business Name): ANGELEKE VAKIAROS PHARMD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 07/11/2020
Certification Date: 07/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 STATE ROAD 54
TRINITY FL
34655-1808
US

IV. Provider business mailing address

18771 BURNDALL CT
LAND O LAKES FL
34638-8213
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-4972
  • Fax:
Mailing address:
  • Phone: 443-600-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS58704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: