Provider Demographics
NPI:1356622740
Name:MCCOLLUM, GEORGE EDDIE (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDDIE
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 NW EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-1559
Mailing Address - Country:US
Mailing Address - Phone:405-773-5069
Mailing Address - Fax:405-773-5137
Practice Address - Street 1:7930 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-1559
Practice Address - Country:US
Practice Address - Phone:405-773-5069
Practice Address - Fax:405-773-5137
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist