Provider Demographics
NPI:1427812759
Name:CAMPBELL, MARK SHERWOOD
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SHERWOOD
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 CORNERSTONE NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2268
Mailing Address - Country:US
Mailing Address - Phone:937-640-6010
Mailing Address - Fax:
Practice Address - Street 1:5300 CORNERSTONE NORTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-2268
Practice Address - Country:US
Practice Address - Phone:937-640-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03316008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist