Provider Demographics
NPI:1053675439
Name:COLLINS, MINDY N
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:N
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 132ND ST SE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9517
Mailing Address - Country:US
Mailing Address - Phone:425-357-6162
Mailing Address - Fax:425-357-6125
Practice Address - Street 1:5006 132ND ST SE
Practice Address - Street 2:BUILDING A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9517
Practice Address - Country:US
Practice Address - Phone:425-357-6162
Practice Address - Fax:425-357-6125
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00069793183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician