Provider Demographics
NPI:1992032056
Name:MA, COLIN K (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:K
Last Name:MA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N JUPITER RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4744
Mailing Address - Country:US
Mailing Address - Phone:972-487-6450
Mailing Address - Fax:972-484-1339
Practice Address - Street 1:1902 N JUPITER RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-4744
Practice Address - Country:US
Practice Address - Phone:972-487-6450
Practice Address - Fax:972-484-1339
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist