Provider Demographics
NPI:1902177413
Name:COLLINS, DAVID ARLIE
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ARLIE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 S COLUMBIA RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2942
Mailing Address - Country:US
Mailing Address - Phone:503-397-0662
Mailing Address - Fax:503-397-0753
Practice Address - Street 1:795 S COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2942
Practice Address - Country:US
Practice Address - Phone:503-397-0662
Practice Address - Fax:503-397-0753
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist