Provider Demographics
NPI:1366803272
Name:CAMPBELL, OLIVIA
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
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 1:4400 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-2108
Mailing Address - Country:US
Mailing Address - Phone:609-888-9854
Mailing Address - Fax:609-888-9882
Practice Address - Street 1:4400 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-2108
Practice Address - Country:US
Practice Address - Phone:609-888-9854
Practice Address - Fax:609-888-9882
Is Sole Proprietor?:No
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02792400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist