Provider Demographics
NPI:1477846418
Name:CAMPBELL, BRYAN L (RPH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:L
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 1:154 PLEASANT RETREAT DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-9561
Mailing Address - Country:US
Mailing Address - Phone:859-792-4013
Mailing Address - Fax:859-792-1406
Practice Address - Street 1:154 PLEASANT RETREAT DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-9561
Practice Address - Country:US
Practice Address - Phone:859-792-4013
Practice Address - Fax:859-792-1406
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist