Provider Demographics
NPI:1396135273
Name:CAMPBELL, MAURICE (RPH)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
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 1:458 N VENICE BYPASS
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292
Mailing Address - Country:US
Mailing Address - Phone:941-412-0282
Mailing Address - Fax:941-412-0483
Practice Address - Street 1:458 US HIGHWAY 41 BYP N
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6037
Practice Address - Country:US
Practice Address - Phone:941-412-0282
Practice Address - Fax:941-412-0483
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist