Provider Demographics
NPI:1427475391
Name:CAMPBELL, WILLIAM OTTO JR (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:OTTO
Last Name:CAMPBELL
Suffix:JR
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 1:140 W BUCKSKIN RD
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541
Mailing Address - Country:US
Mailing Address - Phone:602-722-7074
Mailing Address - Fax:
Practice Address - Street 1:401 E ST HWY 260
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4932
Practice Address - Country:US
Practice Address - Phone:928-472-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS006237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist