Provider Demographics
NPI:1093052953
Name:CAMPBELL, WYNTER LEE
Entity Type:Individual
Prefix:DR
First Name:WYNTER
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 COURTLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-8913
Mailing Address - Country:US
Mailing Address - Phone:407-321-5421
Mailing Address - Fax:407-321-5833
Practice Address - Street 1:605 COURTLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-8913
Practice Address - Country:US
Practice Address - Phone:407-321-5421
Practice Address - Fax:407-321-5833
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist