Provider Demographics
NPI:1689331670
Name:AFFUM, COLLINS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COLLINS
Middle Name:
Last Name:AFFUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1825 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2925
Mailing Address - Country:US
Mailing Address - Phone:847-784-8028
Mailing Address - Fax:
Practice Address - Street 1:1825 WILLOW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2925
Practice Address - Country:US
Practice Address - Phone:847-784-8032
Practice Address - Fax:847-784-8032
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist