Provider Demographics
NPI:1861606824
Name:COLLISON, TERESA CATHERINE (RPH)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:CATHERINE
Last Name:COLLISON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 TOM STEARMAN RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42782
Mailing Address - Country:US
Mailing Address - Phone:270-932-5999
Mailing Address - Fax:
Practice Address - Street 1:407 COLUMBIA HWY
Practice Address - Street 2:SUITE D
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743
Practice Address - Country:US
Practice Address - Phone:270-299-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist