Provider Demographics
NPI:1801895842
Name:COLLIER PHARMACY LLC
Entity type:Organization
Organization Name:COLLIER PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-234-2011
Mailing Address - Street 1:111 S COURT SQ
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3511
Mailing Address - Country:US
Mailing Address - Phone:870-234-2011
Mailing Address - Fax:870-234-5574
Practice Address - Street 1:111 S COURT SQ
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3511
Practice Address - Country:US
Practice Address - Phone:870-234-2011
Practice Address - Fax:870-234-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
ARAR120393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR208050407Medicaid
2148531OtherPK
2148531OtherPK
AR133740716Medicaid
AR0412039OtherPAID PRESCRIPTIONS