Provider Demographics
NPI:1508418112
Name:COLLA, IESHA M (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:IESHA
Middle Name:M
Last Name:COLLA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 971
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0971
Mailing Address - Country:US
Mailing Address - Phone:337-692-1840
Mailing Address - Fax:
Practice Address - Street 1:11343 US HIGHWAY 319 N
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-3419
Practice Address - Country:US
Practice Address - Phone:229-226-5424
Practice Address - Fax:229-226-5048
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist