=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174563498
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER D CAMPBELL PHARM.D., CDE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 877 JEFFERSON AVE REGIONAL MEDICAL CENTER AT MEMPHIS
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38103-2807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-545-8242
-----------------------------------------------------
Fax | 901-545-7184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1531 FORREST AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38112-4922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-545-8242
-----------------------------------------------------
Fax | 901-545-7184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 10828
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------