Provider Demographics
NPI:1760763429
Name:COLLINS, JOHN WALTER JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WALTER
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11161 E WHISPERING RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8069
Mailing Address - Country:US
Mailing Address - Phone:480-280-4642
Mailing Address - Fax:
Practice Address - Street 1:11161 E WHISPERING RIDGE WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8069
Practice Address - Country:US
Practice Address - Phone:480-280-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist