Provider Demographics
NPI:1548940505
Name:CAMAK ENTERPRISES LLC
Entity type:Organization
Organization Name:CAMAK ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOINER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-839-0773
Mailing Address - Street 1:1341 SHALLOW LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-5139
Mailing Address - Country:US
Mailing Address - Phone:270-839-0773
Mailing Address - Fax:
Practice Address - Street 1:4048 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4950
Practice Address - Country:US
Practice Address - Phone:270-839-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy