Provider Demographics
NPI:1538500061
Name:COLLINS, JENNIFER REID (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REID
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 1:1011 MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPEEDWAY
Mailing Address - State:IN
Mailing Address - Zip Code:46224-6977
Mailing Address - Country:US
Mailing Address - Phone:317-957-9062
Mailing Address - Fax:317-957-9952
Practice Address - Street 1:1011 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224-6977
Practice Address - Country:US
Practice Address - Phone:317-957-9062
Practice Address - Fax:317-957-9952
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025021A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist