Provider Demographics
NPI:1518562065
Name:COLLUM, RHONDA (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:
Last Name:COLLUM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MS
Other - First Name:RHONDA
Other - Middle Name:
Other - Last Name:COLLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:E7647
Mailing Address - Street 1:112 STRIBLING LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-6600
Mailing Address - Country:US
Mailing Address - Phone:601-664-7226
Mailing Address - Fax:601-664-0749
Practice Address - Street 1:112 STRIBLING LN
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-6600
Practice Address - Country:US
Practice Address - Phone:601-664-7226
Practice Address - Fax:601-664-0749
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7647OtherPHARMACY BOARD