Provider Demographics
NPI:1275905218
Name:COLLINS, ERICA (PHARM D)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:5717 NE 138TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-3409
Mailing Address - Country:US
Mailing Address - Phone:503-261-7580
Mailing Address - Fax:503-261-2048
Practice Address - Street 1:5717 NE 138TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-3409
Practice Address - Country:US
Practice Address - Phone:503-261-7580
Practice Address - Fax:503-261-2048
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00051605183500000X
ORRPH-00110161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist