Provider Demographics
NPI:1396042875
Name:COLLIE, WALTER BERNARD (RPH)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:BERNARD
Last Name:COLLIE
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 1:1119 EASTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-3113
Mailing Address - Country:US
Mailing Address - Phone:336-869-0362
Mailing Address - Fax:336-885-1708
Practice Address - Street 1:1119 EASTCHESTER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3113
Practice Address - Country:US
Practice Address - Phone:336-869-0362
Practice Address - Fax:336-885-1708
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist