Provider Demographics
NPI:1902193626
Name:CAMERON, MARCUS FREDERICK (RPH)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:FREDERICK
Last Name:CAMERON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 CAROLINA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-1807
Mailing Address - Country:US
Mailing Address - Phone:910-791-7658
Mailing Address - Fax:910-791-5570
Practice Address - Street 1:2607 CAROLINA BEACH RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-1807
Practice Address - Country:US
Practice Address - Phone:910-791-7658
Practice Address - Fax:910-791-5570
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist