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General NPI Number Information
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NPI Number | 1750473617
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Entity Type | Individual
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Provider Name | PETER CAMPO
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 1400 VFW PARKWAY
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City | WEST ROXBURY
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State | MA
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Zip | 02132
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Country | US
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Telephone | 857-203-5459
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Fax |
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Provider Business Mailing Address
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Address Line | 27 BROOK BEND RD
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City | HANOVER
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State | MA
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Zip | 02339-2301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 24525
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License Number State | MA
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