Provider Demographics
NPI:1851514293
Name:COLLINS, MICHAEL E (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
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 1:2544 MCLEOD DR N STE 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2854
Mailing Address - Country:US
Mailing Address - Phone:989-791-1691
Mailing Address - Fax:
Practice Address - Street 1:2544 MCLEOD DR N
Practice Address - Street 2:SUITE #2
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2854
Practice Address - Country:US
Practice Address - Phone:989-791-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366563819OtherPHARMACY NPI
MI5302024326OtherSTATE LICENSE NUMBER