Provider Demographics
NPI:1144227166
Name:CAMPBELL DRUG INCORPORATED
Entity Type:Organization
Organization Name:CAMPBELL DRUG INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:405-707-3005
Mailing Address - Street 1:406 E HALL OF FAME AVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5428
Mailing Address - Country:US
Mailing Address - Phone:405-707-3005
Mailing Address - Fax:405-707-3033
Practice Address - Street 1:406 E HALL OF FAME AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5428
Practice Address - Country:US
Practice Address - Phone:405-707-3005
Practice Address - Fax:405-707-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5294220001332B00000X
OK84901333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3724033OtherNCPDP NUMBER
OK3724033OtherNCPDP NUMBER