Provider Demographics
NPI:1720373368
Name:CAMP, NICOLE ANN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:CAMP
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16959 EVANS PLZ
Mailing Address - Street 2:T2326
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2388
Mailing Address - Country:US
Mailing Address - Phone:402-970-1001
Mailing Address - Fax:402-970-1011
Practice Address - Street 1:16959 EVANS PLZ
Practice Address - Street 2:T2326
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2388
Practice Address - Country:US
Practice Address - Phone:402-970-1001
Practice Address - Fax:402-970-1011
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist