Provider Demographics
NPI:1962683383
Name:CAMPBELL, MARYBETH (RPH)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
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 1:175 MIDTOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2005
Mailing Address - Country:US
Mailing Address - Phone:585-546-2448
Mailing Address - Fax:585-546-7598
Practice Address - Street 1:175 MIDTOWN PLZ
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2005
Practice Address - Country:US
Practice Address - Phone:585-546-2448
Practice Address - Fax:585-546-7598
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist