Provider Demographics
NPI:1851618987
Name:CAMEO PHARMACY LLC
Entity Type:Organization
Organization Name:CAMEO PHARMACY LLC
Other - Org Name:CAMEO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-572-5562
Mailing Address - Street 1:1326 S PINE AVE
Mailing Address - Street 2:# 202
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6542
Mailing Address - Country:US
Mailing Address - Phone:352-433-2990
Mailing Address - Fax:352-433-2993
Practice Address - Street 1:1326 S PINE AVE
Practice Address - Street 2:# 202
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6542
Practice Address - Country:US
Practice Address - Phone:352-433-2990
Practice Address - Fax:352-433-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH246013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5700326OtherNCPDP PROVIDER IDENTIFICATION NUMBER