Provider Demographics
NPI:1417403981
Name:CAMPBELL, SHANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
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 1:194 PAUGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:WV
Mailing Address - Zip Code:26055-1341
Mailing Address - Country:US
Mailing Address - Phone:304-455-2171
Mailing Address - Fax:304-455-2174
Practice Address - Street 1:193 N STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1610
Practice Address - Country:US
Practice Address - Phone:304-455-2171
Practice Address - Fax:304-455-2174
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist