Provider Demographics
NPI:1952514333
Name:COLLINS, SAVITRA ANTOINE (R PH)
Entity Type:Individual
Prefix:MRS
First Name:SAVITRA
Middle Name:ANTOINE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 WILLOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-0977
Mailing Address - Country:US
Mailing Address - Phone:337-367-1907
Mailing Address - Fax:
Practice Address - Street 1:1411 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544-3505
Practice Address - Country:US
Practice Address - Phone:337-276-4249
Practice Address - Fax:337-276-7472
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist