Provider Demographics
NPI:1710005152
Name:CAMPBELL, RICHARD ANTONIO (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTONIO
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12663 CHAPELTOWN CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5299
Mailing Address - Country:US
Mailing Address - Phone:904-221-8881
Mailing Address - Fax:
Practice Address - Street 1:8775 OLD KINGS RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4827
Practice Address - Country:US
Practice Address - Phone:904-636-5666
Practice Address - Fax:904-636-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS-32970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist