Healthcare Provider Details

I. General information

NPI: 1497766034
Provider Name (Legal Business Name): CAMARATO DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 RUSHING DR
HERRIN IL
62948-3749
US

IV. Provider business mailing address

PO BOX 398
HERRIN IL
62948-0398
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-5555
  • Fax: 618-993-6800
Mailing address:
  • Phone: 618-993-5555
  • Fax: 618-993-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54014826
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATT CAMARATO
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 618-993-5555