Active NPI
Randall Lavelle Camp
- Pharmacist
- Ellisville, MS
National Provider Identifier
1154935765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- R-06559
- Practice address
- 915 Hill St
Ellisville, MS 39437-2419 - Phone
- (601) 477-3573
- Fax
- (601) 477-3572
- NPI assigned
- Sep 1, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | R-06559 | MS | Primary |
Addresses
Primary practice location
915 Hill St
Ellisville, MS 39437-2419
Mailing address
110 Timberton Dr
Hattiesburg, MS 39401-9043
Phone (601) 408-5568
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-06559 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1154935765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 TIMBERTON DR",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394019043",
"telephone_number": "601-408-5568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 HILL ST",
"city": "ELLISVILLE",
"state": "MS",
"postal_code": "394372419",
"telephone_number": "601-477-3573",
"fax_number": "601-477-3572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMP",
"first_name": "RANDALL",
"middle_name": "LAVELLE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-01",
"last_updated": "2020-09-01",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "R-06559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellisville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.