1144227166 NPI number — CAMPBELL DRUG INCORPORATED

Table of content: (NPI 1144227166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144227166 NPI number — CAMPBELL DRUG INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMPBELL DRUG INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144227166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 E HALL OF FAME AVE
Provider Second Line Business Mailing Address:
SUITE 100A
Provider Business Mailing Address City Name:
STILLWATER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74075-5428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-707-3005
Provider Business Mailing Address Fax Number:
405-707-3033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 E HALL OF FAME AVE
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
STILLWATER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74075-5428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-707-3005
Provider Business Practice Location Address Fax Number:
405-707-3033
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
MAURY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
405-707-3005

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5294220001 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 333600000X , with the licence number: 84901 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3724033 . This is a "NCPDP NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com