Provider Demographics
NPI:1053097246
Name:CAMPBELL, AUSTIN (PHARMD, BCPP)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 E RAITT RD
Mailing Address - Street 2:
Mailing Address - City:HARTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65039-8000
Mailing Address - Country:US
Mailing Address - Phone:660-537-1589
Mailing Address - Fax:
Practice Address - Street 1:101 S FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7637
Practice Address - Country:US
Practice Address - Phone:573-882-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080284071835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist