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General NPI Number Information
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NPI Number | 1851673065
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Entity Type | Individual
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Provider Name | DONALD CRISP VICKERS JR. RPH BCNSP
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Gender | Male
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 1414 KUHL AVE ORLANDO REGIONAL MEDICAL CENTER DEPT OF PHARMACY
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City | ORLANDO
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State | FL
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Zip | 32806-2008
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Country | US
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Telephone | 321-841-5327
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Fax | 407-649-6839
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Provider Business Mailing Address
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Address Line | 5954 SHORE BREEZE LN
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City | ORLANDO
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State | FL
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Zip | 32810-5031
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Country | US
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Telephone | 407-927-4160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PS 18603
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License Number State | FL
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Taxonomy #2
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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 | 10040
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License Number State | AL
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