Provider Demographics
NPI:1730645995
Name:COLLINS FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:COLLINS FAMILY PHARMACY LLC
Other - Org Name:KING'S DAUGHTERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:254-778-1731
Mailing Address - Street 1:1105 DRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7168
Mailing Address - Country:US
Mailing Address - Phone:254-698-0734
Mailing Address - Fax:254-791-2266
Practice Address - Street 1:1905 SW H K DODGEN LOOP STE 101
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-778-1731
Practice Address - Fax:254-791-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
067BQLZF1OtherHIN
TX150033Medicaid
TX32593OtherSTATE PHARMACY LICENSE TX
PANP001532OtherNON-RESIDENT PHARMACY LICENSE