Provider Demographics
NPI:1407967904
Name:CAMPBELL, CHARLES PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PETER
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 1:1606 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1459
Mailing Address - Country:US
Mailing Address - Phone:989-892-5491
Mailing Address - Fax:989-892-9166
Practice Address - Street 1:1606 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-1459
Practice Address - Country:US
Practice Address - Phone:989-892-5491
Practice Address - Fax:989-892-9166
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist