Healthcare Provider Details

I. General information

NPI: 1477087468
Provider Name (Legal Business Name): CAMERON STANEK PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12216 N NC HIGHWAY 150
WINSTON SALEM NC
27127-9730
US

IV. Provider business mailing address

1055 STAFFORD PLACE CIR APT. 303
WINSTON SALEM NC
27127-6870
US

V. Phone/Fax

Practice location:
  • Phone: 336-764-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26665
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: