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General NPI Number Information
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NPI Number | 1710877675
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Entity Type | Individual
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Provider Name | CASEY DERDERIAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7221 NORMANDY BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32205-6260
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Country | US
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Telephone | 904-783-1109
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Fax |
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Provider Business Mailing Address
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Address Line | 10135 GATE PKWY N APT 713
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8260
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Country | US
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Telephone | 401-714-1786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS69485
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PSI47735
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License Number State | FL
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