1851673065 NPI number — MR. DONALD CRISP VICKERS JR. RPH BCNSP

Table of content: MR. DONALD CRISP VICKERS JR. RPH BCNSP (NPI 1851673065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851673065 NPI number — MR. DONALD CRISP VICKERS JR. RPH BCNSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VICKERS
Provider First Name:
DONALD
Provider Middle Name:
CRISP
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
RPH BCNSP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851673065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5954 SHORE BREEZE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32810-5031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-927-4160
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 KUHL AVE
Provider Second Line Business Practice Location Address:
ORLANDO REGIONAL MEDICAL CENTER DEPT OF PHARMACY
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-841-5327
Provider Business Practice Location Address Fax Number:
407-649-6839
Provider Enumeration Date:
09/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  PS 18603 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1835P0018X , with the licence number: 10040 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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