Provider Demographics
NPI:1790056315
Name:COLLINS, TERENCE
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 S FALKENBURG RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-2561
Mailing Address - Country:US
Mailing Address - Phone:813-732-7365
Mailing Address - Fax:813-626-1171
Practice Address - Street 1:2760 S FALKENBURG RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2561
Practice Address - Country:US
Practice Address - Phone:813-732-7365
Practice Address - Fax:813-626-1171
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0026709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist