Provider Demographics
NPI:1114588969
Name:CAMERON, JACOB M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:M
Last Name:CAMERON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 NAGEL RD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:440-695-2450
Mailing Address - Fax:440-695-2465
Practice Address - Street 1:1810 NAGEL RD
Practice Address - Street 2:PHARMACY
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:440-695-2450
Practice Address - Fax:440-695-2465
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist