Provider Demographics
NPI:1851673065
Name:VICKERS, DONALD CRISP JR (RPH BCNSP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CRISP
Last Name:VICKERS
Suffix:JR
Gender:M
Credentials:RPH BCNSP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5954 SHORE BREEZE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5031
Mailing Address - Country:US
Mailing Address - Phone:407-927-4160
Mailing Address - Fax:
Practice Address - Street 1:1414 KUHL AVE
Practice Address - Street 2:ORLANDO REGIONAL MEDICAL CENTER DEPT OF PHARMACY
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:321-841-5327
Practice Address - Fax:407-649-6839
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPS 186031835P0018X
AL100401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist