Healthcare Provider Details

I. General information

NPI: 1154714988
Provider Name (Legal Business Name): ROBERT CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 LOS OSOS VALLEY RD
LOS OSOS CA
93402-3373
US

IV. Provider business mailing address

1240 LOS OSOS VALLEY RD
LOS OSOS CA
93402-3373
US

V. Phone/Fax

Practice location:
  • Phone: 805-528-0244
  • Fax: 805-528-0372
Mailing address:
  • Phone: 805-528-0244
  • Fax: 805-528-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: