Provider Demographics
NPI:1508145939
Name:COLLINS, RANDI LEAHANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:LEAHANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W STONE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3221
Mailing Address - Country:US
Mailing Address - Phone:423-247-4171
Mailing Address - Fax:
Practice Address - Street 1:128 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3221
Practice Address - Country:US
Practice Address - Phone:423-247-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211193183500000X
KY015574183500000X
TN0000038143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist