Provider Demographics
NPI:1245506013
Name:COLLETTE, BARBARA LOUISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LOUISE
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 DINNER LAKE LOOP
Mailing Address - Street 2:LAKE WALES
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-2153
Mailing Address - Country:US
Mailing Address - Phone:407-908-3806
Mailing Address - Fax:
Practice Address - Street 1:217 DINNER LAKE LOOP
Practice Address - Street 2:LAKE WALES
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-2153
Practice Address - Country:US
Practice Address - Phone:407-908-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37734183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist