Provider Demographics
NPI:1477876779
Name:CAMPION, BONNIE (RPH)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:CAMPION
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 1:5547 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-4090
Mailing Address - Country:US
Mailing Address - Phone:252-261-8097
Mailing Address - Fax:
Practice Address - Street 1:5547 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-4090
Practice Address - Country:US
Practice Address - Phone:252-261-8097
Practice Address - Fax:252-261-0654
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13638183500000X
AZS08466183500000X
VA0202009239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist