Provider Demographics
NPI:1073125639
Name:CAMPBELL, EDWARD L
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 GUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-1846
Mailing Address - Country:US
Mailing Address - Phone:256-582-2513
Mailing Address - Fax:256-582-2985
Practice Address - Street 1:1400 GUNTER AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1846
Practice Address - Country:US
Practice Address - Phone:256-582-2513
Practice Address - Fax:256-582-2985
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist