Provider Demographics
NPI:1477943033
Name:CAMPBELL, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MARLOW DR
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:MA
Mailing Address - Zip Code:01235-9210
Mailing Address - Country:US
Mailing Address - Phone:413-655-8761
Mailing Address - Fax:
Practice Address - Street 1:655 CHESHIRE RD
Practice Address - Street 2:
Practice Address - City:LANESBORO
Practice Address - State:MA
Practice Address - Zip Code:01237-9706
Practice Address - Country:US
Practice Address - Phone:413-236-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician