1558447763 NPI number — CAMPS MEDICAL PHARMACY

Table of Contents

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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