Provider Demographics
NPI:1780466078
Name:COLLIER, BRENT ALLEN (RPH)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ALLEN
Last Name:COLLIER
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 1:6009 WINDHAM DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6551
Mailing Address - Country:US
Mailing Address - Phone:806-584-0401
Mailing Address - Fax:
Practice Address - Street 1:1701 N 23RD ST
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-7962
Practice Address - Country:US
Practice Address - Phone:806-655-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist