MEDICARE: COLLINS RX LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1457169948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLINS RX LLC

Provider Business Mailing Address
First Line	:	2160 N COLLINS ST # 120
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2877
Country	:	US
Telephone Number	:	469-307-6162
Fax Number	:	817-720-5553

Provider Business Practice Location Address
First Line	:	2160 N COLLINS ST # 120
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2877
Country	:	US
Telephone Number	:	469-307-6162
Fax Number	:	817-720-5553

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MAHATHI KANKANALA
Credential	:
Telephone Number	:	817-720-5552

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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Directions to “COLLINS RX LLC ” Practice Location

Language	Start Address	Practice Location

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