Provider Demographics
NPI:1558447763
Name:CAMPS MEDICAL PHARMACY
Entity Type:Organization
Organization Name:CAMPS MEDICAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-910-5550
Mailing Address - Street 1:800 SOUTH CHURCH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-910-5550
Mailing Address - Fax:870-910-5552
Practice Address - Street 1:800 SOUTH CHURCH
Practice Address - Street 2:SUITE 103
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-910-5550
Practice Address - Fax:870-910-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0421204OtherNABP PHARMACY PROVIDER NU
AR140878407Medicaid
AR142035716Medicaid
AR142035716Medicaid
AR0421204OtherNABP PHARMACY PROVIDER NU