Healthcare Provider Details

I. General information

NPI: 1205650959
Provider Name (Legal Business Name): CAMERON TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S OAK ST
NEVADA MO
64772-3436
US

IV. Provider business mailing address

612 N SPRING ST
NEVADA MO
64772-2111
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-7802
  • Fax:
Mailing address:
  • Phone: 402-995-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2024044754
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: