Healthcare Provider Details

I. General information

NPI: 1346814977
Provider Name (Legal Business Name): KATHRYN COLLINS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 08/01/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11080 W OLYMPIC BLVD
LOS ANGELES CA
90064-1937
US

IV. Provider business mailing address

115 N CATALINA ST
LOS ANGELES CA
90004-4601
US

V. Phone/Fax

Practice location:
  • Phone: 310-966-6500
  • Fax:
Mailing address:
  • Phone: 502-889-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82725
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRPH82725
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH82725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: