Provider Demographics
NPI:1649811209
Name:DAVIS, CAMILLE J (PHARMD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:J
Last Name:DAVIS
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 1:632 S 100 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2864
Mailing Address - Country:US
Mailing Address - Phone:801-465-2591
Mailing Address - Fax:801-465-5198
Practice Address - Street 1:632 S 100 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2864
Practice Address - Country:US
Practice Address - Phone:801-465-2591
Practice Address - Fax:801-465-5198
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2774254-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist