Provider Demographics
NPI:1093141681
Name:BRIAN, CAMILLE (RPH)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:BRIAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W PEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8327
Mailing Address - Country:US
Mailing Address - Phone:352-672-4600
Mailing Address - Fax:
Practice Address - Street 1:350 W PEBBLE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-8327
Practice Address - Country:US
Practice Address - Phone:352-672-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT33436-1701183500000X
FLPS43475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist