Provider Demographics
NPI:1427835677
Name:CAMPBELL, AUTUMN SUE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:SUE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SINGING HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-5162
Mailing Address - Country:US
Mailing Address - Phone:712-252-4905
Mailing Address - Fax:712-252-5092
Practice Address - Street 1:3400 SINGING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-5162
Practice Address - Country:US
Practice Address - Phone:712-252-4905
Practice Address - Fax:712-252-5092
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist