Healthcare Provider Details

I. General information

NPI: 1417604596
Provider Name (Legal Business Name): CAMERON JAMES ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 HWY 7 S
JEREMIAH KY
41826
US

IV. Provider business mailing address

PO BOX 393
ISOM KY
41824-0393
US

V. Phone/Fax

Practice location:
  • Phone: 606-634-9887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberI14769
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: