Provider Demographics
NPI:1235783473
Name:CAMPBELL, TAVAJAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAVAJAY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MADISON ST APT 255
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-1676
Mailing Address - Country:US
Mailing Address - Phone:347-599-5902
Mailing Address - Fax:
Practice Address - Street 1:4928 EDMONDSON PIKE STE 205
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4791
Practice Address - Country:US
Practice Address - Phone:615-222-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN423461835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care