Provider Demographics
NPI:1144820952
Name:EXUM, VICKY CARTER
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:CARTER
Last Name:EXUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 BELLE MEADOW BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5957
Mailing Address - Country:US
Mailing Address - Phone:850-207-8125
Mailing Address - Fax:
Practice Address - Street 1:2650 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7382
Practice Address - Country:US
Practice Address - Phone:850-479-2228
Practice Address - Fax:850-479-1990
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11505183500000X
FLPS24774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist