Provider Demographics
NPI:1518090927
Name:COLLIER, MARK CHESTER (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHESTER
Last Name:COLLIER
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 1:1223 BUCK CREEK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:KY
Mailing Address - Zip Code:42327-9604
Mailing Address - Country:US
Mailing Address - Phone:270-733-0218
Mailing Address - Fax:
Practice Address - Street 1:509 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1429
Practice Address - Country:US
Practice Address - Phone:812-649-2227
Practice Address - Fax:812-649-3253
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019442A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist