Provider Demographics
NPI:1700169943
Name:CAMPBELL, KELLI L (RPH)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2310
Mailing Address - Country:US
Mailing Address - Phone:978-739-1582
Mailing Address - Fax:
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-3116
Practice Address - Country:US
Practice Address - Phone:978-276-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist