Provider Demographics
NPI:1316277304
Name:CAMPBELL, ANDREA LAUREN-NICOLE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LAUREN-NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 S 172ND DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6074
Mailing Address - Country:US
Mailing Address - Phone:602-743-1451
Mailing Address - Fax:
Practice Address - Street 1:17088 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2433
Practice Address - Country:US
Practice Address - Phone:623-544-0667
Practice Address - Fax:623-544-0982
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist