Provider Demographics
NPI:1275787046
Name:CAMPBELL, BRUCE D (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:D
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 1:1330 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3316
Mailing Address - Country:US
Mailing Address - Phone:718-552-2278
Mailing Address - Fax:718-552-2280
Practice Address - Street 1:1330 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3316
Practice Address - Country:US
Practice Address - Phone:718-552-2278
Practice Address - Fax:718-552-2280
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030050183500000X
CT0004429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02759988Medicaid