Provider Demographics
NPI:1710003058
Name:COLLINS, HEATHER MARIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1703
Mailing Address - Country:US
Mailing Address - Phone:608-831-1718
Mailing Address - Fax:
Practice Address - Street 1:2510 ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2212
Practice Address - Country:US
Practice Address - Phone:608-831-1321
Practice Address - Fax:608-831-3970
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13570-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist