Provider Demographics
NPI:1700148558
Name:COLLINS, ANTHONY J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:J
Other - Last Name:AMENDOLIA
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 DRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7168
Mailing Address - Country:US
Mailing Address - Phone:267-254-4817
Mailing Address - Fax:254-791-2266
Practice Address - Street 1:1905 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-778-1731
Practice Address - Fax:254-791-2266
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4394791835G0303X
PARPI000841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX55715OtherTEXAS RPH LICENSE
ARPD13886OtherARKANSAS RPH LICENSE
KY019072OtherKENTUCKY RPH LICENSE
MI5302046256OtherMICHIGAN RPH LICENSE
OK17383OtherOKLAHOMA RPH LICENSE
MST-15093OtherMISSISSIPPI RPH LICENSE
MD25350OtherMARYLAND RPH LICENSE
LAPST.022028OtherLOUISIANA RPH LICENSE