Provider Demographics
NPI:1104292424
Name:CAMPBELL, KAHLIL (PHARM D)
Entity type:Individual
Prefix:
First Name:KAHLIL
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7209
Mailing Address - Country:US
Mailing Address - Phone:480-832-9660
Mailing Address - Fax:480-832-9676
Practice Address - Street 1:5122 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7209
Practice Address - Country:US
Practice Address - Phone:480-832-9660
Practice Address - Fax:480-832-9676
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist