Healthcare Provider Details

I. General information

NPI: 1669985826
Provider Name (Legal Business Name): TORI LYND COLLINS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CORPORATE DR
HOUMA LA
70360-2767
US

IV. Provider business mailing address

4891 IMPERIAL DR
HOUMA LA
70360-2840
US

V. Phone/Fax

Practice location:
  • Phone: 985-580-9996
  • Fax:
Mailing address:
  • Phone: 985-852-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022260
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: