Provider Demographics
NPI:1164244125
Name:CAMPO, GRACE (RPH)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CAMPO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:CAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GRACE SCHARFENSTEIN
Mailing Address - Street 1:4001 PINNACLE PKWY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 PINNACLE PKWY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6052
Practice Address - Country:US
Practice Address - Phone:985-249-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist