Healthcare Provider Details

I. General information

NPI: 1053202986
Provider Name (Legal Business Name): LAURA CAMPOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E BROADWAY
NEWPORT TN
37821-2323
US

IV. Provider business mailing address

102 E BROADWAY
NEWPORT TN
37821-2323
US

V. Phone/Fax

Practice location:
  • Phone: 423-623-0364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49089
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: