Provider Demographics
NPI:1952063836
Name:COLLINS, HENRY RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:RICHARD
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14861 BONNYBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4119
Mailing Address - Country:US
Mailing Address - Phone:172-764-4386
Mailing Address - Fax:
Practice Address - Street 1:14861 BONNYBRIDGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4119
Practice Address - Country:US
Practice Address - Phone:727-644-3861
Practice Address - Fax:497-641-8905
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS282131835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric