Provider Demographics
NPI:1568537421
Name:COLLINS PRESCRIPTION PHARMACY
Entity Type:Organization
Organization Name:COLLINS PRESCRIPTION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARM. D
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-778-0555
Mailing Address - Street 1:8473 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1519
Mailing Address - Country:US
Mailing Address - Phone:323-778-0555
Mailing Address - Fax:323-788-5657
Practice Address - Street 1:8473 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1519
Practice Address - Country:US
Practice Address - Phone:323-778-0555
Practice Address - Fax:323-788-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA412590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA412590Medicaid