Provider Demographics
NPI:1669190278
Name:CAMPBELL, ELIZABETH JANE (PHARMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:JANE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1405 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-7905
Mailing Address - Country:US
Mailing Address - Phone:270-472-9802
Mailing Address - Fax:
Practice Address - Street 1:1405 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-7905
Practice Address - Country:US
Practice Address - Phone:270-472-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46628183500000X
KY022899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist