Provider Demographics
NPI:1912342635
Name:CAMERON, KELLIE LEEANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:LEEANN
Last Name:CAMERON
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 1:4810 ROSSVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37407-3524
Mailing Address - Country:US
Mailing Address - Phone:423-867-6390
Mailing Address - Fax:
Practice Address - Street 1:4810 ROSSVILLE BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37407-3524
Practice Address - Country:US
Practice Address - Phone:423-867-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10590390200000X
TN40416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program