Provider Demographics
NPI:1295718971
Name:DICKENS, JAMES RICHARD (PHARMD CGP)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:DICKENS
Suffix:
Gender:M
Credentials:PHARMD CGP
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:407-468-1997
Mailing Address - Fax:407-386-3282
Practice Address - Street 1:975 FLORIDA CENTRAL PKWY
Practice Address - Street 2:SUITE 1800
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-7661
Practice Address - Country:US
Practice Address - Phone:407-261-5800
Practice Address - Fax:407-260-5725
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU48581835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy