Provider Demographics
NPI:1376106625
Name:CAMPBELL, MARILYN KAY (RPH)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:KAY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W AMERICAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3123
Mailing Address - Country:US
Mailing Address - Phone:806-272-7511
Mailing Address - Fax:
Practice Address - Street 1:1411 W AMERICAN BLVD
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3123
Practice Address - Country:US
Practice Address - Phone:806-272-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist