Provider Demographics
NPI:1952064149
Name:COLLINS, MARTHA CLAIRE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:CLAIRE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-0424
Mailing Address - Country:US
Mailing Address - Phone:229-522-3040
Mailing Address - Fax:229-522-3074
Practice Address - Street 1:92 E BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1832
Practice Address - Country:US
Practice Address - Phone:229-522-3040
Practice Address - Fax:229-522-3074
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist