Provider Demographics
NPI:1659009959
Name:COLLINS, CASSIUS SHEMAR
Entity Type:Individual
Prefix:
First Name:CASSIUS
Middle Name:SHEMAR
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1419
Mailing Address - Country:US
Mailing Address - Phone:419-865-3130
Mailing Address - Fax:419-865-6639
Practice Address - Street 1:2450 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1419
Practice Address - Country:US
Practice Address - Phone:419-865-3130
Practice Address - Fax:419-865-6639
Is Sole Proprietor?:No
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09216314183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician