Provider Demographics
NPI:1659543254
Name:COLLINS, ANGELA ORR
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ORR
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 TEMPLETON LOOP
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-6559
Mailing Address - Country:US
Mailing Address - Phone:318-237-7688
Mailing Address - Fax:318-281-1336
Practice Address - Street 1:2017 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4070
Practice Address - Country:US
Practice Address - Phone:318-281-6646
Practice Address - Fax:318-281-1336
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist