Active NPI
Maksim Dudenkov
- Pharmacist
- Jacksonville, FL
National Provider Identifier
1508657487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS57804
- Practice address
- 11555 Central Pkwy
Jacksonville, FL 32224-2691 - Phone
- (904) 885-2785
- NPI assigned
- May 13, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS57804 | FL | Primary |
Addresses
Primary practice location
11555 Central Pkwy
Jacksonville, FL 32224-2691
Mailing address
11555 Central Pkwy
Jacksonville, FL 32224-2691
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS57804 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747094400000",
"number": "1508657487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11555 CENTRAL PKWY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322242691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11555 CENTRAL PKWY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322242691",
"telephone_number": "904-885-2785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDENKOV",
"first_name": "MAKSIM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-05-13",
"last_updated": "2025-05-13",
"certification_date": "2025-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS57804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.