Provider Demographics
NPI:1093726374
Name:CAMPBELL, DIANA COVINGTON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:COVINGTON
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BAKERSWOOD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5578
Mailing Address - Country:US
Mailing Address - Phone:210-601-8423
Mailing Address - Fax:210-568-4541
Practice Address - Street 1:3019 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-1708
Practice Address - Country:US
Practice Address - Phone:210-227-5262
Practice Address - Fax:210-224-9710
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist