Provider Demographics
NPI:1134511637
Name:COLLINS, LARRY DALE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DALE
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 LOCKE LN LOT 21
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2244
Mailing Address - Country:US
Mailing Address - Phone:337-540-9902
Mailing Address - Fax:
Practice Address - Street 1:4828 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5214
Practice Address - Country:US
Practice Address - Phone:337-477-9068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist