MEDICARE: CAMP PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	125726	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2073854	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376628503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMP PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 117
Second Line	:
City	:	RATLIFF CITY
State	:	OK
Zip	:	73481-0117
Country	:	US
Telephone Number	:	580-856-3333
Fax Number	:	580-856-3607

Provider Business Practice Location Address
First Line	:	1 MEDICAL PLAZA
Second Line	:
City	:	RATLIFF CITY
State	:	OK
Zip	:	73481
Country	:	US
Telephone Number	:	580-856-3333
Fax Number	:	580-856-3607

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	SUE ROGERS
Credential	:
Telephone Number	:	580-856-3333

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/22/2016

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Directions to “CAMP PHARMACY LLC ” Practice Location

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