Provider Demographics
NPI:1851476808
Name:COLLINS, SHERI T (RPH)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:T
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:T
Other - Last Name:GHRIGSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2337
Mailing Address - Country:US
Mailing Address - Phone:601-437-5121
Mailing Address - Fax:601-437-5102
Practice Address - Street 1:1005 MARKET ST
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2337
Practice Address - Country:US
Practice Address - Phone:601-636-5214
Practice Address - Fax:601-636-5272
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00033618Medicaid