Provider Demographics
NPI:1558812040
Name:VAN, CAMERON CHHOUR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:CHHOUR
Last Name:VAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CAM
Other - Middle Name:
Other - Last Name:VAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1800 CAVITT DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6235
Mailing Address - Country:US
Mailing Address - Phone:916-850-1005
Mailing Address - Fax:916-850-1023
Practice Address - Street 1:1800 CAVITT DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6235
Practice Address - Country:US
Practice Address - Phone:916-850-1005
Practice Address - Fax:916-850-1023
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist