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General NPI Number Information
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NPI Number | 1295236578
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Entity Type | Organization
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Legal Business Name | CENTER FOR CHRONIC DISEASE MANAGEMENT AND EDUCATION LLC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 1381 CROSS CREEK CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32301-3729
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Country | US
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Telephone | 850-877-6393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7011
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City | TALLAHASSEE
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State | FL
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Zip | 32314-7011
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Country | US
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Telephone | 850-284-6873
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. OTIS WILBUR KIRKSEY
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Credential | PHARMD, BC-ADM, CDE
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Telephone | 850-284-6873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PS20980
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License Number State | FL
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