Provider Demographics
NPI:1558450288
Name:CAMPORELLI, GLENN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:CAMPORELLI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 SUWANNEE CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3804
Mailing Address - Country:US
Mailing Address - Phone:916-206-9375
Mailing Address - Fax:
Practice Address - Street 1:6600 BRUCEVILLE RD
Practice Address - Street 2:INPATIENT PHARMACY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4671
Practice Address - Country:US
Practice Address - Phone:916-688-2529
Practice Address - Fax:916-688-2973
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40212183500000X
NV9210183500000X
HIPH-2768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist