Provider Demographics
NPI:1780068478
Name:COLLINS, PENNY (RPH)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:49 SGT PRENTISS DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4727
Mailing Address - Country:US
Mailing Address - Phone:601-446-8275
Mailing Address - Fax:601-446-9562
Practice Address - Street 1:49 SGT PRENTISS DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4727
Practice Address - Country:US
Practice Address - Phone:601-446-8275
Practice Address - Fax:601-446-9562
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist