Provider Demographics
NPI:1700194131
Name:COLLINS, SHEILA MAE (PD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MAE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-3501
Mailing Address - Country:US
Mailing Address - Phone:501-332-2101
Mailing Address - Fax:501-337-9532
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-3501
Practice Address - Country:US
Practice Address - Phone:501-332-2101
Practice Address - Fax:501-337-9532
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist