Healthcare Provider Details

I. General information

NPI: 1912567975
Provider Name (Legal Business Name): JOSEPH CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 INDIAN RIVER RD
CHESAPEAKE VA
23325-3116
US

IV. Provider business mailing address

4300 INDIAN RIVER RD
CHESAPEAKE VA
23325-3116
US

V. Phone/Fax

Practice location:
  • Phone: 757-420-8418
  • Fax:
Mailing address:
  • Phone: 757-420-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209895
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: