Provider Demographics
NPI:1225551005
Name:COLLINS, MEGHAN ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SW GREEN ACRES WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-0689
Mailing Address - Country:US
Mailing Address - Phone:386-365-8470
Mailing Address - Fax:
Practice Address - Street 1:3330 INNER PERIMETER RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7063
Practice Address - Country:US
Practice Address - Phone:229-671-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist