Provider Demographics
NPI:1700963055
Name:COLLINS, BRADLEY A (RPH)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:COLLINS
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 1:700 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-1115
Mailing Address - Country:US
Mailing Address - Phone:740-992-1388
Mailing Address - Fax:740-992-1608
Practice Address - Street 1:700 E MAIN ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-1115
Practice Address - Country:US
Practice Address - Phone:740-992-1388
Practice Address - Fax:740-992-1608
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist