1700148558 NPI number — DR. ANTHONY J COLLINS PHARMD

Table of content: DR. ANTHONY J COLLINS PHARMD (NPI 1700148558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700148558 NPI number — DR. ANTHONY J COLLINS PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
ANTHONY
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMENDOLIA
Provider Other First Name:
ANTHONY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700148558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 DRY RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARKER HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76548-7168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-254-4817
Provider Business Mailing Address Fax Number:
254-791-2266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1905 SW H K DODGEN LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76502-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-778-1731
Provider Business Practice Location Address Fax Number:
254-791-2266
Provider Enumeration Date:
06/07/2012

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: 1835G0303X , with the licence number:  RP439479 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: RPI000841 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: PST.022028 . This is a "LOUISIANA RPH LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: T-15093 . This is a "MISSISSIPPI RPH LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 17383 . This is a "OKLAHOMA RPH LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 55715 . This is a "TEXAS RPH LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".