Healthcare Provider Details

I. General information

NPI: 1174563498
Provider Name (Legal Business Name): JENNIFER D CAMPBELL PHARM.D., CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE REGIONAL MEDICAL CENTER AT MEMPHIS
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

1531 FORREST AVE
MEMPHIS TN
38112-4922
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-8242
  • Fax: 901-545-7184
Mailing address:
  • Phone: 901-545-8242
  • Fax: 901-545-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number10828
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: