Provider Demographics
NPI:1407453798
Name:COLLINS, JEFFERY THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:THOMAS
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-1309
Mailing Address - Country:US
Mailing Address - Phone:660-646-1280
Mailing Address - Fax:
Practice Address - Street 1:1210 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1309
Practice Address - Country:US
Practice Address - Phone:660-646-1280
Practice Address - Fax:660-646-1146
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist