Provider Demographics
NPI:1154633824
Name:COLLIER, DEDRA (RPH)
Entity Type:Individual
Prefix:
First Name:DEDRA
Middle Name:
Last Name:COLLIER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 INTERNATIONAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5781
Mailing Address - Country:US
Mailing Address - Phone:866-846-0052
Mailing Address - Fax:866-846-0065
Practice Address - Street 1:300 INTERNATIONAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5781
Practice Address - Country:US
Practice Address - Phone:866-846-0052
Practice Address - Fax:866-846-0065
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0332451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist