Healthcare Provider Details

I. General information

NPI: 1033104922
Provider Name (Legal Business Name): MONA G TSOUKLERIS PHARM.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N PINE ST PH S404
BALTIMORE MD
21201-1142
US

IV. Provider business mailing address

PO BOX 333
COLUMBIA MD
21045-0333
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-8312
  • Fax: 410-706-4725
Mailing address:
  • Phone: 410-706-8312
  • Fax: 410-706-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number11109
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: