Healthcare Provider Details

I. General information

NPI: 1063584381
Provider Name (Legal Business Name): KEVIN CAMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18294 BROAD ST
HENAGAR AL
35978-4374
US

IV. Provider business mailing address

18294 BROAD ST
HENAGAR AL
35978-4374
US

V. Phone/Fax

Practice location:
  • Phone: 256-657-5187
  • Fax: 256-657-2232
Mailing address:
  • Phone: 256-657-5187
  • Fax: 256-657-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13788
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: