Provider Demographics
NPI:1093082588
Name:CAMPBELL, LATOYA S (PHARMD)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-4727
Mailing Address - Country:US
Mailing Address - Phone:954-695-6226
Mailing Address - Fax:
Practice Address - Street 1:3599 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6723
Practice Address - Country:US
Practice Address - Phone:954-741-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5158637164W00000X
FLPS47030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No164W00000XNursing Service ProvidersLicensed Practical Nurse