Provider Demographics
NPI:1811760192
Name:COLLIE, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:COLLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W RIO SALADO PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3812
Mailing Address - Country:US
Mailing Address - Phone:833-289-9678
Mailing Address - Fax:
Practice Address - Street 1:1201 FANNIN ST STE 262
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-6943
Practice Address - Country:US
Practice Address - Phone:800-338-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04003800183500000X
NY065239183500000X
SC41966183500000X
FLPS65817183500000X
NC28581183500000X
OK18399183500000X
TX34347183500000X
IA23516183500000X
NV20139183500000X
KY020608183500000X
LAPST.022955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist