1851476808 NPI number — SHERI T COLLINS RPH

Table of content: SHERI T COLLINS RPH (NPI 1851476808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851476808 NPI number — SHERI T COLLINS RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
SHERI
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GHRIGSBY
Provider Other First Name:
SHERI
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851476808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT GIBSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39150-2337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-437-5121
Provider Business Mailing Address Fax Number:
601-437-5102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT GIBSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39150-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-636-5214
Provider Business Practice Location Address Fax Number:
601-636-5272
Provider Enumeration Date:
10/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  E08776 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00033618 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".