Healthcare Provider Details

I. General information

NPI: 1194306035
Provider Name (Legal Business Name): HECTOR CAMACHO PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 OLIVEHURST AVE
OLIVEHURST CA
95961-4225
US

IV. Provider business mailing address

4897 OLIVEHURST AVE
OLIVEHURST CA
95961-4225
US

V. Phone/Fax

Practice location:
  • Phone: 530-743-5451
  • Fax: 530-743-3713
Mailing address:
  • Phone: 530-743-5451
  • Fax: 530-743-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH44302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: