Provider Demographics
NPI:1952620627
Name:HOPE, CAMILLE MINETTA (RPH)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MINETTA
Last Name:HOPE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17858 BERG RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2232
Mailing Address - Country:US
Mailing Address - Phone:313-655-8951
Mailing Address - Fax:
Practice Address - Street 1:17858 BERG RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2232
Practice Address - Country:US
Practice Address - Phone:313-655-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist