Provider Demographics
NPI:1588318901
Name:CAMARATO, STEPHANIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:CAMARATO
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 1:8216 GRASSY RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-0492
Mailing Address - Country:US
Mailing Address - Phone:618-925-1331
Mailing Address - Fax:618-993-6800
Practice Address - Street 1:303 RUSHING DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3749
Practice Address - Country:US
Practice Address - Phone:618-993-5555
Practice Address - Fax:618-993-6800
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-039997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist