Provider Demographics
NPI:1700185576
Name:CAMPBELL, D'ANDREA R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:D'ANDREA
Middle Name:R
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 1:380 W WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7657
Mailing Address - Country:US
Mailing Address - Phone:601-713-1130
Mailing Address - Fax:601-981-9634
Practice Address - Street 1:380 W WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7657
Practice Address - Country:US
Practice Address - Phone:601-713-1130
Practice Address - Fax:601-981-9634
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist