Provider Demographics
NPI:1861112112
Name:CAMP, DONNA J (PD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:J
Last Name:CAMP
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 E JOHNSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8837
Mailing Address - Country:US
Mailing Address - Phone:870-910-5550
Mailing Address - Fax:870-910-5552
Practice Address - Street 1:4109 E JOHNSON AVE STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-8837
Practice Address - Country:US
Practice Address - Phone:870-910-5550
Practice Address - Fax:870-910-5552
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140878407Medicaid