Provider Demographics
NPI:1811773179
Name:ADDISON, CAMILLE NORA (PHARMD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:NORA
Last Name:ADDISON
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 1:7373 VALLEY VIEW LN APT 1116
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5550
Mailing Address - Country:US
Mailing Address - Phone:913-219-3336
Mailing Address - Fax:
Practice Address - Street 1:6420 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4022
Practice Address - Country:US
Practice Address - Phone:469-334-0758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist