Provider Demographics
NPI:1578848073
Name:CAMPBELL, RALPH KIMSEY JR (DPH)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:KIMSEY
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:DUCKTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37326-0039
Mailing Address - Country:US
Mailing Address - Phone:423-496-5831
Mailing Address - Fax:423-496-7111
Practice Address - Street 1:125 FIVE POINTS DRIVE
Practice Address - Street 2:
Practice Address - City:DUCKTOWN
Practice Address - State:TN
Practice Address - Zip Code:37326-0039
Practice Address - Country:US
Practice Address - Phone:423-496-5831
Practice Address - Fax:423-496-7111
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist