Provider Demographics
NPI:1568758555
Name:CAMPBELL DRUG INCORPORATED
Entity Type:Organization
Organization Name:CAMPBELL DRUG INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-707-3005
Mailing Address - Street 1:610 E MCELROY RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-7415
Mailing Address - Country:US
Mailing Address - Phone:405-707-3005
Mailing Address - Fax:405-707-3033
Practice Address - Street 1:610 E MCELROY RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-7415
Practice Address - Country:US
Practice Address - Phone:405-707-3005
Practice Address - Fax:405-707-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK855823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200038620AMedicaid
OK5294220001Medicare NSC