Healthcare Provider Details

I. General information

NPI: 1629368949
Provider Name (Legal Business Name): MARCUS WILLIAM CAMPBELL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TGMG SUN CITY CENTER 16521 SOUTH US HWY 301
WIMAUMA FL
33598
US

IV. Provider business mailing address

714 147TH CT NE
BRADENTON FL
34212-5588
US

V. Phone/Fax

Practice location:
  • Phone: 813-660-6770
  • Fax: 813-844-1979
Mailing address:
  • Phone: 217-778-9802
  • Fax: 813-844-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number45002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: