Provider Demographics
NPI:1831476100
Name:GERVASI, CAMILLE (RPH)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:GERVASI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3149
Mailing Address - Country:US
Mailing Address - Phone:781-837-2482
Mailing Address - Fax:
Practice Address - Street 1:2177 OCEAN ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-3149
Practice Address - Country:US
Practice Address - Phone:781-837-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist