MEDICARE: AMANDA CAMPBELL PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	59224	TX

General Provider Information

NPI Number	:	1437781358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CAMPBELL PHARMD

Provider Business Mailing Address
First Line	:	1950 EL DORADO BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-3621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 EL DORADO BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-3621
Country	:	US
Telephone Number	:	281-480-7092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2020
Last Update Date	:	02/08/2020

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Directions to “ AMANDA CAMPBELL PHARMD” Practice Location

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