Provider Demographics
NPI:1790067635
Name:CAMPBELL, DOUGLASS STUART (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLASS
Middle Name:STUART
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 1:1251 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2710
Mailing Address - Country:US
Mailing Address - Phone:641-423-2034
Mailing Address - Fax:641-423-0527
Practice Address - Street 1:1251 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2710
Practice Address - Country:US
Practice Address - Phone:641-423-2034
Practice Address - Fax:641-423-0527
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist