Healthcare Provider Details

I. General information

NPI: 1194031997
Provider Name (Legal Business Name): HEATHER MARY CAMERON R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 CORPOREX PARK DR SUITE 100
TAMPA FL
33619-1183
US

IV. Provider business mailing address

3801 CORPOREX PARK DR SUITE 100
TAMPA FL
33619-1183
US

V. Phone/Fax

Practice location:
  • Phone: 908-389-1818
  • Fax:
Mailing address:
  • Phone: 908-389-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS 41728
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number28RI02342400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: