Provider Demographics
NPI:1659539716
Name:KIRKSEY, OTIS WILBUR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OTIS
Middle Name:WILBUR
Last Name:KIRKSEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32307-0001
Mailing Address - Country:US
Mailing Address - Phone:850-561-2688
Mailing Address - Fax:850-599-3347
Practice Address - Street 1:438 W BREVARD ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1004
Practice Address - Country:US
Practice Address - Phone:850-561-2688
Practice Address - Fax:850-599-3347
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist