Provider Demographics
NPI:1518391671
Name:COLLINS, TRENELL R (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:TRENELL
Middle Name:R
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 1:1801 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2303
Mailing Address - Country:US
Mailing Address - Phone:504-324-6632
Mailing Address - Fax:504-324-8017
Practice Address - Street 1:1801 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-2303
Practice Address - Country:US
Practice Address - Phone:504-324-6632
Practice Address - Fax:504-324-8017
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist