Healthcare Provider Details

I. General information

NPI: 1205477627
Provider Name (Legal Business Name): CAMERON PETER BENSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 S MAIN ST
CENTERVILLE UT
84014-1817
US

IV. Provider business mailing address

26 S MAIN ST
CENTERVILLE UT
84014-1817
US

V. Phone/Fax

Practice location:
  • Phone: 802-693-7950
  • Fax: 801-693-7955
Mailing address:
  • Phone: 802-693-7950
  • Fax: 801-693-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6583631-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: