Provider Demographics
NPI:1386312122
Name:POLIKANDRIOTIS, NICHOLAS KONSTANTINOS (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:KONSTANTINOS
Last Name:POLIKANDRIOTIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 CHESACO AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2738
Mailing Address - Country:US
Mailing Address - Phone:443-610-4888
Mailing Address - Fax:
Practice Address - Street 1:401 COMPASS RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-3509
Practice Address - Country:US
Practice Address - Phone:410-780-4770
Practice Address - Fax:443-780-9254
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist