Provider Demographics
NPI:1417604596
Name:ADAMS, CAMERON JAMES
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:JAMES
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:ISOM
Mailing Address - State:KY
Mailing Address - Zip Code:41824-0393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4133 HWY 7 S
Practice Address - Street 2:
Practice Address - City:JEREMIAH
Practice Address - State:KY
Practice Address - Zip Code:41826
Practice Address - Country:US
Practice Address - Phone:606-634-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYI14769183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician