Provider Demographics
NPI:1730487059
Name:CAMPBELL, SHEPARDSON WILLCOX (RPH)
Entity type:Individual
Prefix:MR
First Name:SHEPARDSON
Middle Name:WILLCOX
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:CABIN CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25035-0280
Mailing Address - Country:US
Mailing Address - Phone:304-786-2853
Mailing Address - Fax:304-595-4652
Practice Address - Street 1:15063 MACCORKLE AVE., SE
Practice Address - Street 2:
Practice Address - City:CABIN CREEK
Practice Address - State:WV
Practice Address - Zip Code:25035
Practice Address - Country:US
Practice Address - Phone:304-595-4900
Practice Address - Fax:304-595-4652
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205975183500000X
WVRP0009480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist