MEDICARE: CAMPBELLS COMPOUNDING INC

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	3336C0003X	Community/Retail Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0004X	Compounding Pharmacy	22522	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2099401	OTHER		PK

General Provider Information

NPI Number	:	1649459678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELLS COMPOUNDING INC

Provider Business Mailing Address
First Line	:	6603 KIRBY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3900
Country	:	US
Telephone Number	:	713-668-4833
Fax Number	:	713-668-4812

Provider Business Practice Location Address
First Line	:	6603 KIRBY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3900
Country	:	US
Telephone Number	:	713-668-4833
Fax Number	:	713-668-4812

Authorized Official
Title or Position	:	OWNER
Name	:	LANCE CAMPBELL
Credential	:	PHARM D
Telephone Number	:	713-668-4833

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	01/20/2015

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Directions to “CAMPBELLS COMPOUNDING INC ” Practice Location

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