Provider Demographics
NPI:1184024689
Name:NODELMAN, CAMRON (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAMRON
Middle Name:
Last Name:NODELMAN
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 1:16130 JOG RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2319
Mailing Address - Country:US
Mailing Address - Phone:561-381-4962
Mailing Address - Fax:
Practice Address - Street 1:16130 JOG RD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2319
Practice Address - Country:US
Practice Address - Phone:561-381-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist