Provider Demographics
NPI:1528079373
Name:CAMPBELL, CLARK GILMAN (RPH)
Entity type:Individual
Prefix:
First Name:CLARK
Middle Name:GILMAN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 MARTINDALE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5317
Mailing Address - Country:US
Mailing Address - Phone:925-229-0517
Mailing Address - Fax:
Practice Address - Street 1:2700 GRANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2266
Practice Address - Country:US
Practice Address - Phone:925-674-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH36362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist