Provider Demographics
NPI:1851789085
Name:COLLINS, CINDY ANNE (DPH)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:ANNE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:MISS
Other - First Name:CINDY
Other - Middle Name:ANNE
Other - Last Name:WILHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:716 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-4006
Mailing Address - Country:US
Mailing Address - Phone:405-406-9108
Mailing Address - Fax:
Practice Address - Street 1:716 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-4006
Practice Address - Country:US
Practice Address - Phone:405-406-9108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist