Provider Demographics
NPI:1912933722
Name:CAMPBELL, MARK CHRISTOPHER (R PH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2771 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2507
Mailing Address - Country:US
Mailing Address - Phone:562-989-8950
Mailing Address - Fax:562-366-4598
Practice Address - Street 1:2321 W OLIVE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2663
Practice Address - Country:US
Practice Address - Phone:818-848-8112
Practice Address - Fax:818-848-8142
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist