Provider Demographics
NPI:1508947789
Name:CAMERON, JENNIFER KATHRYN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KATHRYN
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 SOUTHERN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-2758
Mailing Address - Country:US
Mailing Address - Phone:228-234-3217
Mailing Address - Fax:
Practice Address - Street 1:209 NORTH CLEVELAND AVE.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560
Practice Address - Country:US
Practice Address - Phone:228-863-0631
Practice Address - Fax:228-863-9174
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE09947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0330285Medicaid