Provider Demographics
NPI:1508140120
Name:CAMPBELL, KELLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 E. COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356
Mailing Address - Country:US
Mailing Address - Phone:219-696-6638
Mailing Address - Fax:219-696-4169
Practice Address - Street 1:1704 E. COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356
Practice Address - Country:US
Practice Address - Phone:219-696-6638
Practice Address - Fax:219-696-4169
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021175A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist