Provider Demographics
NPI:1811569247
Name:WLASCHIN, CAMERON A (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:A
Last Name:WLASCHIN
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 1:1201 HILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6601
Mailing Address - Country:US
Mailing Address - Phone:307-286-9318
Mailing Address - Fax:
Practice Address - Street 1:3150 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5237
Practice Address - Country:US
Practice Address - Phone:205-967-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist