Provider Demographics
NPI:1821699224
Name:TRIKERIOTIS, PENELOPE DIAMANDARAS
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:DIAMANDARAS
Last Name:TRIKERIOTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 DUNSTAN LANE
Mailing Address - Street 2:
Mailing Address - City:MONTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111
Mailing Address - Country:US
Mailing Address - Phone:410-420-2961
Mailing Address - Fax:
Practice Address - Street 1:1401 ROCK SPRING RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-1920
Practice Address - Country:US
Practice Address - Phone:410-420-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist