Healthcare Provider Details

I. General information

NPI: 1316631344
Provider Name (Legal Business Name): CAMERON SWEENEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 W MAIN ST
ST CHARLES IL
60175-1004
US

IV. Provider business mailing address

35W940 FIELDCREST DR
ST CHARLES IL
60175-5171
US

V. Phone/Fax

Practice location:
  • Phone: 630-443-8735
  • Fax:
Mailing address:
  • Phone: 630-345-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.305426
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: