Provider Demographics
NPI:1396340220
Name:CAMPBELL, MARCI RENE' (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARCI
Middle Name:RENE'
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 1:110 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1242
Mailing Address - Country:US
Mailing Address - Phone:217-774-5513
Mailing Address - Fax:
Practice Address - Street 1:110 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1242
Practice Address - Country:US
Practice Address - Phone:217-774-5513
Practice Address - Fax:217-774-5653
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051040614OtherPHARMACY LICENSE