Provider Demographics
NPI:1902939101
Name:DEWITT, VICKIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:
Last Name:DEWITT
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 1:700 W NORVELL BRYANT HWY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34442-6101
Mailing Address - Country:US
Mailing Address - Phone:352-249-3143
Mailing Address - Fax:
Practice Address - Street 1:700 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:CITRUS HILLS
Practice Address - State:FL
Practice Address - Zip Code:34442-6101
Practice Address - Country:US
Practice Address - Phone:352-249-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0031050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist