Provider Demographics
NPI:1790943934
Name:COLLINS, RICHARD E (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:COLLINS
Suffix:
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 1:285 SILLS RD BLDG 8
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:917-307-2946
Mailing Address - Fax:631-981-5528
Practice Address - Street 1:7 ANDE CT
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715-2201
Practice Address - Country:US
Practice Address - Phone:917-307-2946
Practice Address - Fax:631-981-5528
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist