Provider Demographics
NPI:1487256830
Name:CAMPBELL, MISTY DAWN (PHARMD)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:DAWN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-3051
Mailing Address - Country:US
Mailing Address - Phone:806-364-4459
Mailing Address - Fax:806-364-4857
Practice Address - Street 1:300 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-3051
Practice Address - Country:US
Practice Address - Phone:806-364-4459
Practice Address - Fax:806-364-4857
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist