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General NPI Number Information
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NPI Number | 1205650959
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Entity Type | Individual
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Provider Name | CAMERON TRAN
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Gender | Male
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 105 S OAK ST
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City | NEVADA
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State | MO
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Zip | 64772-3436
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Country | US
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Telephone | 417-667-7802
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Fax |
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Provider Business Mailing Address
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Address Line | 612 N SPRING ST
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City | NEVADA
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State | MO
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Zip | 64772-2111
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Country | US
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Telephone | 402-995-1323
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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 | 2024044754
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License Number State | MO
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