Provider Demographics
NPI:1285819953
Name:COLLINS, MICHAEL EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:COLLINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 STATE ROUTE 104 EAST
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-342-2212
Mailing Address - Fax:315-342-2225
Practice Address - Street 1:341 STATE ROUTE 104
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2911
Practice Address - Country:US
Practice Address - Phone:315-342-2212
Practice Address - Fax:315-342-2225
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00484368Medicaid