Provider Demographics
NPI:1083846422
Name:DICKENS, KANDI LANE (RPH)
Entity Type:Individual
Prefix:
First Name:KANDI
Middle Name:LANE
Last Name:DICKENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 BAYBORO CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7606
Mailing Address - Country:US
Mailing Address - Phone:407-509-7880
Mailing Address - Fax:
Practice Address - Street 1:5449 S SEMORAN BLVD # 14
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1722
Practice Address - Country:US
Practice Address - Phone:407-367-0928
Practice Address - Fax:407-367-1074
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist