Provider Demographics
NPI:1689266447
Name:CAMPBELL, URSULA (RPH)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:CAMPBELL
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 1:608 E MERCURY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-2231
Mailing Address - Country:US
Mailing Address - Phone:757-723-0714
Mailing Address - Fax:757-951-0108
Practice Address - Street 1:FOOD LION
Practice Address - Street 2:608 E MERCURY BLVD
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-2366
Practice Address - Country:US
Practice Address - Phone:757-723-0714
Practice Address - Fax:757-951-0108
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202007526OtherBOARD OF PHARMACY