Provider Demographics
NPI:1700111572
Name:CAMPBELL, CHARLOTTE R (RPH, CGP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 RUBY VISTA DR
Mailing Address - Street 2:#305
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-1641
Mailing Address - Country:US
Mailing Address - Phone:801-201-8202
Mailing Address - Fax:
Practice Address - Street 1:515 SHOSHONE CIR
Practice Address - Street 2:SBHC PHARMACY
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-5072
Practice Address - Country:US
Practice Address - Phone:775-748-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT311073-17011835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric