Provider Demographics
NPI:1871719054
Name:HATFIELD, CAMERON KEITH (RPH)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:KEITH
Last Name:HATFIELD
Suffix:
Gender:M
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:HC 65 BOX 299
Mailing Address - Street 2:
Mailing Address - City:CLEAR FORK
Mailing Address - State:WV
Mailing Address - Zip Code:24822-9614
Mailing Address - Country:US
Mailing Address - Phone:304-682-8132
Mailing Address - Fax:
Practice Address - Street 1:22 LARRY HARLESS DRIVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:WV
Practice Address - Zip Code:25621
Practice Address - Country:US
Practice Address - Phone:304-664-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0003321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist