Provider Demographics
NPI:1437772753
Name:COLLINS, CYNTHIA E (RPH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16066 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1294
Mailing Address - Country:US
Mailing Address - Phone:773-412-3882
Mailing Address - Fax:
Practice Address - Street 1:16066 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1294
Practice Address - Country:US
Practice Address - Phone:773-412-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist