MEDICARE: DR. COLLINS U AIGBOGUN PHARMD

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	22214	NC
2	183500000X	Pharmacist	21848	IA

General Provider Information

NPI Number	:	1396088274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLINS U AIGBOGUN PHARMD

Provider Business Mailing Address
First Line	:	608 E 5TH ST
Second Line	:	SUITE 001
City	:	LUMBERTON
State	:	NC
Zip	:	28358-5593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 FAYETTEVILLE RD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2781
Country	:	US
Telephone Number	:	910-739-7511
Fax Number	:

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

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	03/29/2013

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