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NPI Code Detail

MEDICARE: EBONI CAMPBELL PHARMD

MEDICARE: EBONI CAMPBELL PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPD11390AR
2183500000XPharmacist34290TN

General Provider Information

NPI Number : 1093082364
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONI CAMPBELL PHARMD
Provider Business Mailing Address
First Line : 4015 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-2503
Country : US
Telephone Number : 901-373-4575
Fax Number : 901-373-5169
Provider Business Practice Location Address
First Line : 4015 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-2503
Country : US
Telephone Number : 901-373-4575
Fax Number : 901-373-5169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2011
Last Update Date : 11/30/2011

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Directions to “ EBONI CAMPBELL PHARMD” Practice Location

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