MEDICARE: DR. KEVIN E COLLIER PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP00008908	NM

General Provider Information

NPI Number	:	1053807875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN E COLLIER PHARM.D

Provider Business Mailing Address
First Line	:	6005 LOS HERMANOS CT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1154
Country	:	US
Telephone Number	:	505-299-4496
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 WYOMING BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3849
Country	:	US
Telephone Number	:	505-299-4496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2018
Last Update Date	:	07/04/2018

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