Provider Demographics
NPI:1134874217
Name:COLLIERVILLE HEALTHCARE CORP
Entity type:Organization
Organization Name:COLLIERVILLE HEALTHCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-542-8001
Mailing Address - Street 1:2130 W POPLAR AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0615
Mailing Address - Country:US
Mailing Address - Phone:901-542-8001
Mailing Address - Fax:901-542-8002
Practice Address - Street 1:2130 W POPLAR AVE STE 104
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0615
Practice Address - Country:US
Practice Address - Phone:901-542-8001
Practice Address - Fax:901-542-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy