Provider Demographics
NPI:1164548681
Name:CAMPBELL, DEREK JEROME V
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JEROME
Last Name:CAMPBELL
Suffix:V
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 1:412 JESSAMINE AVE
Mailing Address - Street 2:
Mailing Address - City:STEELTON
Mailing Address - State:PA
Mailing Address - Zip Code:17113-2454
Mailing Address - Country:US
Mailing Address - Phone:717-939-6641
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:610-834-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician