Healthcare Provider Details

I. General information

NPI: 1467928176
Provider Name (Legal Business Name): DOUGLAS MERL CAMP RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

820 COURT ST
FULTON MO
65251-1970
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8600
  • Fax:
Mailing address:
  • Phone: 573-355-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042352
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: