Provider Demographics
NPI:1851707509
Name:CAMPBELL, CHARMAINE HORTENSE
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:HORTENSE
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 1:1247 FLATBUSH AVE APT 4K
Mailing Address - Street 2:APT4K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7668
Mailing Address - Country:US
Mailing Address - Phone:917-675-9867
Mailing Address - Fax:
Practice Address - Street 1:1247 FLATBUSH AVE
Practice Address - Street 2:APT4K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7606
Practice Address - Country:US
Practice Address - Phone:917-675-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036864-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist