Provider Demographics
NPI:1245909159
Name:CAMARENA, KAELA-MARIE MAY (PHARMD)
Entity type:Individual
Prefix:
First Name:KAELA-MARIE
Middle Name:MAY
Last Name:CAMARENA
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 1:326 SLOW MILL DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-9640
Mailing Address - Country:US
Mailing Address - Phone:757-880-4274
Mailing Address - Fax:
Practice Address - Street 1:8910 OLD 6 HWY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142
Practice Address - Country:US
Practice Address - Phone:803-854-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist