Provider Demographics
NPI:1134325566
Name:CAMP, KENNETH LEONARD (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEONARD
Last Name:CAMP
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 1:529 PORTOBELLO DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3266
Mailing Address - Country:US
Mailing Address - Phone:904-683-5393
Mailing Address - Fax:
Practice Address - Street 1:529 PORTOBELLO DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-3266
Practice Address - Country:US
Practice Address - Phone:904-683-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 27298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist