Provider Demographics
NPI:1174846893
Name:CAMPBELL, IAN ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:ANTHONY
Last Name:CAMPBELL
Suffix:
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 1:14893 CITRUS GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4358
Mailing Address - Country:US
Mailing Address - Phone:561-317-4776
Mailing Address - Fax:
Practice Address - Street 1:1590 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5957
Practice Address - Country:US
Practice Address - Phone:561-966-1052
Practice Address - Fax:561-966-1057
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist