Provider Demographics
NPI:1639258890
Name:COLLIER'S MEDICINE ON TIME
Entity Type:Organization
Organization Name:COLLIER'S MEDICINE ON TIME
Other - Org Name:COLLIER'S PERSONAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:678-441-0045
Mailing Address - Street 1:5 DUNWOODY PARK STE 102
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6710
Mailing Address - Country:US
Mailing Address - Phone:678-441-0045
Mailing Address - Fax:678-441-0079
Practice Address - Street 1:5 DUNWOODY PARK STE 102
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6710
Practice Address - Country:US
Practice Address - Phone:678-441-0045
Practice Address - Fax:678-441-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87873336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA059022393AMedicaid
GA5118980001Medicare NSC