Provider Demographics
NPI:1366609810
Name:COLLINS, COREY O (PHARM D)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:O
Last Name:COLLINS
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:PO BOX 4065
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33424-4065
Mailing Address - Country:US
Mailing Address - Phone:850-212-6739
Mailing Address - Fax:
Practice Address - Street 1:9881 CORONADO LAKE DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045263183500000X
MI5302033113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI874750671Medicaid
MI470E01882OtherBCBS OF MICHIGAN
MI470E01882OtherBCBS OF MICHIGAN