Healthcare Provider Details

I. General information

NPI: 1386563856
Provider Name (Legal Business Name): XAVIER COLLMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 BRYAN RD
O FALLON MO
63366-3709
US

IV. Provider business mailing address

1 CVS DR
WOONSOCKET RI
02895-6195
US

V. Phone/Fax

Practice location:
  • Phone: 636-281-0189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026031229
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: