Provider Demographics
NPI:1720746761
Name:CAMPBELL, JANIE CAROL
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:CAROL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-0352
Mailing Address - Country:US
Mailing Address - Phone:209-589-4533
Mailing Address - Fax:
Practice Address - Street 1:1449 E F ST STE 102
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-9266
Practice Address - Country:US
Practice Address - Phone:209-847-4279
Practice Address - Fax:209-848-3210
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31415183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician