Provider Demographics
NPI:1548752421
Name:PASSEY, CAMERIN CORDELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAMERIN
Middle Name:CORDELL
Last Name:PASSEY
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 1:830 JACKSON ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-4941
Mailing Address - Country:US
Mailing Address - Phone:208-530-0894
Mailing Address - Fax:
Practice Address - Street 1:679 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-6000
Practice Address - Country:US
Practice Address - Phone:307-885-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4046183500000X
IDP8007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist