Provider Demographics
NPI:1659373090
Name:CAMPBELL, TAMMY R
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:R
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 1:197 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:VA
Mailing Address - Zip Code:24586-3251
Mailing Address - Country:US
Mailing Address - Phone:434-793-5711
Mailing Address - Fax:434-792-2516
Practice Address - Street 1:155 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2921
Practice Address - Country:US
Practice Address - Phone:434-792-0726
Practice Address - Fax:434-792-2516
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4805822OtherNABP