Healthcare Provider Details

I. General information

NPI: 1952063836
Provider Name (Legal Business Name): HENRY RICHARD COLLINS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14861 BONNYBRIDGE DR
ORLANDO FL
32826-4119
US

IV. Provider business mailing address

14861 BONNYBRIDGE DR
ORLANDO FL
32826-4119
US

V. Phone/Fax

Practice location:
  • Phone: 727-644-3861
  • Fax: 497-641-8905
Mailing address:
  • Phone: 172-764-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS28213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: