Provider Demographics
NPI:1871861682
Name:CAMPBELL, KELLY MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
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 1:6650 TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-5342
Mailing Address - Country:US
Mailing Address - Phone:303-791-1523
Mailing Address - Fax:303-791-5685
Practice Address - Street 1:6650 TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-5342
Practice Address - Country:US
Practice Address - Phone:303-791-1523
Practice Address - Fax:303-791-5685
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist