Provider Demographics
NPI:1215927090
Name:CAMPBELL, RICHARD KEITH (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KEITH
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-9104
Mailing Address - Country:US
Mailing Address - Phone:573-359-0008
Mailing Address - Fax:573-359-6376
Practice Address - Street 1:308 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1639
Practice Address - Country:US
Practice Address - Phone:573-359-0009
Practice Address - Fax:573-359-6376
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist