Provider Demographics
NPI:1275744666
Name:CAMPBELL, CHERYL A
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
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 1:360 W WINDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MARKLE
Mailing Address - State:IN
Mailing Address - Zip Code:46770
Mailing Address - Country:US
Mailing Address - Phone:260-758-2606
Mailing Address - Fax:
Practice Address - Street 1:222 N WAYNE ST
Practice Address - Street 2:WARREN PHARMACY
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792
Practice Address - Country:US
Practice Address - Phone:260-375-2135
Practice Address - Fax:260-375-7030
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67000312A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician