Basic Information
| Provider Information | |||||||||
| NPI: | 1497177893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7623 S SORRELL LN | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852989747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802730881 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2946 E BANNER GATEWAY DR | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852342165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802565450 | ||||||||
| FaxNumber: | 4802565451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2014 | ||||||||
| LastUpdateDate: | 06/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | S015553 | AZ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.