Healthcare Provider Details

I. General information

NPI: 1316903024
Provider Name (Legal Business Name): KRYSTAL M CAMERON R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LOOP RD TUSCALOOSA VA MEDICAL CENTER
TUSCALOOSA AL
35404-5015
US

IV. Provider business mailing address

3701 LOOP RD TUSCALOOSA VA MEDICAL CENTER
TUSCALOOSA AL
35404-5015
US

V. Phone/Fax

Practice location:
  • Phone: 205-554-2822
  • Fax: 205-554-2894
Mailing address:
  • Phone: 205-554-2822
  • Fax: 205-554-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12866
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: