Active NPI
Casey Derderian, PHARMD
- Pharmacist
- Jacksonville, FL
National Provider Identifier
1710877675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS69485
- Practice address
- 7221 Normandy Blvd
Jacksonville, FL 32205-6260 - Phone
- (904) 783-1109
- NPI assigned
- Jul 3, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS69485 | FL | Primary |
| Pharmacy Technician | 183700000X | PSI47735 | FL |
Addresses
Primary practice location
7221 Normandy Blvd
Jacksonville, FL 32205-6260
Mailing address
10135 Gate Pkwy N Apt 713
Jacksonville, FL 32246-8260
Phone (401) 714-1786
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS69485 | FL | MD | Pharmacist |
| PSI47735 | FL | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Jacksonville, FL
- NPI 1336156322
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- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1710877675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10135 GATE PKWY N APT 713",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322468260",
"telephone_number": "401-714-1786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7221 NORMANDY BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322056260",
"telephone_number": "904-783-1109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERDERIAN",
"first_name": "CASEY",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-03",
"last_updated": "2025-09-11",
"certification_date": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS69485",
"primary": true
},
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "FL",
"license": "PSI47735",
"primary": false
}
],
"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 Sep 11, 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.