Provider Demographics
NPI:1043859143
Name:COLLINS, CODY (RPH)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:COLLINS
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 1:4300 NC HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7527
Mailing Address - Country:US
Mailing Address - Phone:704-455-6420
Mailing Address - Fax:
Practice Address - Street 1:4300 NC HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7527
Practice Address - Country:US
Practice Address - Phone:704-455-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist