Provider Demographics
NPI:1861597726
Name:CAMPBELL PHARMACY
Entity type:Organization
Organization Name:CAMPBELL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:205-674-3566
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:3925 VETERANS MEMORIAL DR
Mailing Address - City:ADAMSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35005
Mailing Address - Country:US
Mailing Address - Phone:205-674-3566
Mailing Address - Fax:205-674-1950
Practice Address - Street 1:3925 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35005
Practice Address - Country:US
Practice Address - Phone:205-674-3566
Practice Address - Fax:205-674-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL103164333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001734Medicaid
AL100001734Medicaid