Provider Demographics
NPI:1033104922
Name:TSOUKLERIS, MONA G (PHARMD,)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:G
Last Name:TSOUKLERIS
Suffix:
Gender:F
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:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-0333
Mailing Address - Country:US
Mailing Address - Phone:410-706-8312
Mailing Address - Fax:410-706-4725
Practice Address - Street 1:20 N PINE ST
Practice Address - Street 2:PH S404
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1142
Practice Address - Country:US
Practice Address - Phone:410-706-8312
Practice Address - Fax:410-706-4725
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111091835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy