Healthcare Provider Details

I. General information

NPI: 1053178657
Provider Name (Legal Business Name): EVELYN DENICE CAMACHO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 RANCHO VISTA BLVD
PALMDALE CA
93551-3582
US

IV. Provider business mailing address

42530 36TH ST W
LANCASTER CA
93536-4104
US

V. Phone/Fax

Practice location:
  • Phone: 661-575-2333
  • Fax:
Mailing address:
  • Phone: 661-350-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: