=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134949480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMPS MEDICAL PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2024
-----------------------------------------------------
Last Update Date | 10/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4109 E JOHNSON AVE
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72405-8837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-910-5550
-----------------------------------------------------
Fax | 870-910-5552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4109 E JOHNSON AVE
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72405-8837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-910-5550
-----------------------------------------------------
Fax | 870-910-5552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | DONNA J CAMP
-----------------------------------------------------
Credential | PD
-----------------------------------------------------
Telephone | 870-910-5550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------