Provider Demographics
NPI:1609617539
Name:CAMPBELL, ALEXA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 SANDY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-9024
Mailing Address - Country:US
Mailing Address - Phone:904-563-5102
Mailing Address - Fax:
Practice Address - Street 1:1565 SANDY SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-9024
Practice Address - Country:US
Practice Address - Phone:904-563-5102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist