Provider Demographics
NPI:1699042499
Name:BIRCH, CAMERON K
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:K
Last Name:BIRCH
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 1:7941 TREE LN
Mailing Address - Street 2:SUIT 201
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2094
Mailing Address - Country:US
Mailing Address - Phone:608-658-4536
Mailing Address - Fax:
Practice Address - Street 1:9741 TREE LANE
Practice Address - Street 2:SUITE 201
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717
Practice Address - Country:US
Practice Address - Phone:608-658-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40195183500000X
NV09228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist