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General NPI Number Information
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NPI Number | 1154935765
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Entity Type | Individual
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Provider Name | RANDALL LAVELLE CAMP
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Gender | Male
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 915 HILL ST
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City | ELLISVILLE
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State | MS
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Zip | 39437-2419
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Country | US
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Telephone | 601-477-3573
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Fax | 601-477-3572
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Provider Business Mailing Address
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Address Line | 110 TIMBERTON DR
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City | HATTIESBURG
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State | MS
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Zip | 39401-9043
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Country | US
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Telephone | 601-408-5568
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Fax |
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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 | R-06559
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License Number State | MS
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