Healthcare Provider Details

I. General information

NPI: 1144820952
Provider Name (Legal Business Name): VICKY CARTER EXUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 CREIGHTON RD
PENSACOLA FL
32504-7382
US

IV. Provider business mailing address

8627 BELLE MEADOW BLVD
PENSACOLA FL
32514-5957
US

V. Phone/Fax

Practice location:
  • Phone: 850-479-2228
  • Fax: 850-479-1990
Mailing address:
  • Phone: 850-207-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11505
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS24774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: