Healthcare Provider Details

I. General information

NPI: 1255314878
Provider Name (Legal Business Name): DUSTIN PAUL CAMPBELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E 2ND ST
MANCHESTER OH
45144-1301
US

IV. Provider business mailing address

4800 ECKMANSVILLE RD
WINCHESTER OH
45697-9719
US

V. Phone/Fax

Practice location:
  • Phone: 937-549-3773
  • Fax:
Mailing address:
  • Phone: 937-695-0984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-26719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: