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General NPI Number Information
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NPI Number | 1063584381
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Entity Type | Individual
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Provider Name | KEVIN CAMP
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/27/2019
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Provider Practice Location Address
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Address Line | 18294 BROAD ST
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City | HENAGAR
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State | AL
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Zip | 35978-4374
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Country | US
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Telephone | 256-657-5187
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Fax | 256-657-2232
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Provider Business Mailing Address
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Address Line | 18294 BROAD ST
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City | HENAGAR
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State | AL
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Zip | 35978-4374
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Country | US
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Telephone | 256-657-5187
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Fax | 256-657-5187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13788
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License Number State | AL
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