Provider Demographics
NPI:1932458940
Name:CAMMACK, JOSEPH G
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:G
Last Name:CAMMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3119
Mailing Address - Country:US
Mailing Address - Phone:360-452-4200
Mailing Address - Fax:360-457-6557
Practice Address - Street 1:424 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3119
Practice Address - Country:US
Practice Address - Phone:360-452-4200
Practice Address - Fax:360-457-6557
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00018447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist