MEDICARE: DR. NOLL L CAMPBELL PHARMD, CGP

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	1835P1200X	Pharmacotherapy Pharmacist	26020917A	IN

General Provider Information

NPI Number	:	1487650727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOLL L CAMPBELL PHARMD, CGP

Provider Business Mailing Address
First Line	:	1054 RESERVE WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1883
Country	:	US
Telephone Number	:	317-639-6671
Fax Number	:	317-630-8772

Provider Business Practice Location Address
First Line	:	1001 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2859
Country	:	US
Telephone Number	:	317-639-6671
Fax Number	:	317-630-8772

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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