Provider Demographics
NPI:1962784983
Name:CAMPBELL, RENEE R (PHARMD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:R
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:424 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2130
Mailing Address - Country:US
Mailing Address - Phone:217-935-1357
Mailing Address - Fax:217-935-5952
Practice Address - Street 1:424 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2130
Practice Address - Country:US
Practice Address - Phone:217-935-1357
Practice Address - Fax:217-935-5952
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist