MEDICARE: MARK CAMMEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	0230017920	VA

General Provider Information

NPI Number	:	1841681137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK CAMMEL

Provider Business Mailing Address
First Line	:	3149 SACRAMENTO DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7622
Country	:	US
Telephone Number	:	757-427-5817
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6119
Country	:	US
Telephone Number	:	757-428-2666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	02/09/2015

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