Healthcare Provider Details

I. General information

NPI: 1336440759
Provider Name (Legal Business Name): TERRY A CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 N MAIN ST
PHOENIX OR
97535-9607
US

IV. Provider business mailing address

959 LA LOMA DR
MEDFORD OR
97504-8608
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-1561
  • Fax:
Mailing address:
  • Phone: 541-441-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH0012469
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0012469
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: