Provider Demographics
NPI:1851062079
Name:HANCOCK, CAMILLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 ROAD 16 1/2
Mailing Address - Street 2:
Mailing Address - City:OTTO
Mailing Address - State:WY
Mailing Address - Zip Code:82434-9714
Mailing Address - Country:US
Mailing Address - Phone:307-271-1095
Mailing Address - Fax:
Practice Address - Street 1:405 W C ST
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410-5052
Practice Address - Country:US
Practice Address - Phone:307-568-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist