1558447763 NPI number — CAMPS MEDICAL PHARMACY

Table of content: (NPI 1558447763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558447763 NPI number — CAMPS MEDICAL PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMPS MEDICAL PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558447763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 SOUTH CHURCH
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-910-5550
Provider Business Mailing Address Fax Number:
870-910-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 SOUTH CHURCH
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-910-5550
Provider Business Practice Location Address Fax Number:
870-910-5552
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMP
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER PHARMACIST
Authorized Official Telephone Number:
870-910-5550

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0421204 . This is a "NABP PHARMACY PROVIDER NU" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 140878407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142035716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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