Provider Demographics
NPI:1538612775
Name:COLLUMS, GRIFFIN TYLER (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GRIFFIN
Middle Name:TYLER
Last Name:COLLUMS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-2206
Mailing Address - Country:US
Mailing Address - Phone:662-902-5095
Mailing Address - Fax:
Practice Address - Street 1:727 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646-2206
Practice Address - Country:US
Practice Address - Phone:662-902-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-24
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE14500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist