Provider Demographics
NPI:1407843337
Name:CAMPBELL, RONALD R (RPH , FACA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RPH , FACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-3113
Mailing Address - Country:US
Mailing Address - Phone:406-873-5342
Mailing Address - Fax:406-873-4714
Practice Address - Street 1:601 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-2804
Practice Address - Country:US
Practice Address - Phone:406-873-5631
Practice Address - Fax:406-873-4714
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT2511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000228202Medicaid
MT0000565084Medicaid
MT2700828OtherNABP # DRUGMART
MT0232030001Medicare ID - Type UnspecifiedDRUGMART