Provider Demographics
NPI:1831498617
Name:COLLINS, STEPHANIE RENEE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HIGHWAY 100
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1214
Mailing Address - Country:US
Mailing Address - Phone:931-729-5005
Mailing Address - Fax:931-729-2339
Practice Address - Street 1:650 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1214
Practice Address - Country:US
Practice Address - Phone:931-729-5005
Practice Address - Fax:931-729-2339
Is Sole Proprietor?:No
Enumeration Date:2011-03-20
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist