Provider Demographics
NPI:1760767743
Name:CAMPBELL, JASON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:CAMPBELL
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 1:116 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:IL
Mailing Address - Zip Code:62092-1054
Mailing Address - Country:US
Mailing Address - Phone:217-374-2222
Mailing Address - Fax:217-374-2220
Practice Address - Street 1:116 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:IL
Practice Address - Zip Code:62092-1054
Practice Address - Country:US
Practice Address - Phone:217-374-2222
Practice Address - Fax:217-374-2220
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293178183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist