Healthcare Provider Details

I. General information

NPI: 1255453296
Provider Name (Legal Business Name): JOSEPH CAMERON ENTREKIN PHARMD, CDM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BUCHANAN ST N
BREMEN GA
30110-1606
US

IV. Provider business mailing address

501 VALLEY RUN DR
BREMEN GA
30110-2411
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-2364
  • Fax: 770-537-3032
Mailing address:
  • Phone: 770-537-3574
  • Fax: 770-537-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number018340
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: