Provider Demographics
NPI:1326441247
Name:CAMPOS, LUMEN FRANCIA
Entity Type:Individual
Prefix:
First Name:LUMEN FRANCIA
Middle Name:
Last Name:CAMPOS
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 1:100 E WALLACE KNEELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2981
Mailing Address - Country:US
Mailing Address - Phone:360-427-0171
Mailing Address - Fax:360-427-0404
Practice Address - Street 1:100 E WALLACE KNEELAND BLVD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2981
Practice Address - Country:US
Practice Address - Phone:360-427-0171
Practice Address - Fax:360-427-0404
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60033240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist