Provider Demographics
NPI:1053374223
Name:CAMPBELL, MAURY LEE (DPH)
Entity type:Individual
Prefix:DR
First Name:MAURY
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E MCELROY RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-7415
Mailing Address - Country:US
Mailing Address - Phone:405-707-3005
Mailing Address - Fax:405-707-3033
Practice Address - Street 1:610 E MCELROY RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-7415
Practice Address - Country:US
Practice Address - Phone:405-707-3005
Practice Address - Fax:405-707-3033
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist