Provider Demographics
NPI:1063584381
Name:CAMP, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18294 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HENAGAR
Mailing Address - State:AL
Mailing Address - Zip Code:35978-4374
Mailing Address - Country:US
Mailing Address - Phone:256-657-5187
Mailing Address - Fax:256-657-5187
Practice Address - Street 1:18294 BROAD ST
Practice Address - Street 2:
Practice Address - City:HENAGAR
Practice Address - State:AL
Practice Address - Zip Code:35978-4374
Practice Address - Country:US
Practice Address - Phone:256-657-5187
Practice Address - Fax:256-657-2232
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13788OtherSTATE LICENSE NUMBER