Provider Demographics
NPI:1578866190
Name:CAMPBELL, TRICIA L (RPH)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40774 MT HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-7745
Mailing Address - Country:US
Mailing Address - Phone:406-883-3674
Mailing Address - Fax:406-883-3694
Practice Address - Street 1:40774 MT HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-7745
Practice Address - Country:US
Practice Address - Phone:406-883-3674
Practice Address - Fax:406-883-3694
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist