Provider Demographics
NPI:1568746550
Name:COLLINS, CLORETTA J (BS PHARM)
Entity Type:Individual
Prefix:MS
First Name:CLORETTA
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 W PATAPSCO AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2816
Mailing Address - Country:US
Mailing Address - Phone:410-646-2059
Mailing Address - Fax:
Practice Address - Street 1:2310 W PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2816
Practice Address - Country:US
Practice Address - Phone:410-646-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09730OtherPHARMACY LIC