Provider Demographics
NPI:1740891456
Name:COLLINS, JORDYN GABRIELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JORDYN
Middle Name:GABRIELLE
Last Name:COLLINS
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 1:833 NE ALSBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2659
Mailing Address - Country:US
Mailing Address - Phone:817-447-8060
Mailing Address - Fax:
Practice Address - Street 1:833 NE ALSBURY BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2659
Practice Address - Country:US
Practice Address - Phone:817-447-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist