Provider Demographics
NPI:1104994276
Name:CAMPBELL, JEFFERY W (BSPHARM, PHARMD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:W
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:BSPHARM, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6752 BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8312
Mailing Address - Country:US
Mailing Address - Phone:901-755-4327
Mailing Address - Fax:
Practice Address - Street 1:85 N DANNY THOMAS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2321
Practice Address - Country:US
Practice Address - Phone:901-544-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist