Provider Demographics
NPI:1821201906
Name:COLLINS, DAVID F (RP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:COLLINS
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1333
Mailing Address - Country:US
Mailing Address - Phone:908-889-4586
Mailing Address - Fax:201-222-1901
Practice Address - Street 1:570 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2302
Practice Address - Country:US
Practice Address - Phone:201-653-4093
Practice Address - Fax:201-222-1901
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01978200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01978200OtherPHARMACIST LICENSE