Provider Demographics
NPI:1902174824
Name:COLLIER, MICHAEL SHANE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHANE
Last Name:COLLIER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 GENTRY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-9412
Mailing Address - Country:US
Mailing Address - Phone:864-878-5332
Mailing Address - Fax:864-878-4837
Practice Address - Street 1:2700 GENTRY MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-9412
Practice Address - Country:US
Practice Address - Phone:864-878-5332
Practice Address - Fax:864-878-4837
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist