Healthcare Provider Details

I. General information

NPI: 1619759776
Provider Name (Legal Business Name): KIMBERLI ANN COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3979 MEDINA RD
AKRON OH
44333-2444
US

IV. Provider business mailing address

3979 MEDINA RD
AKRON OH
44333-2444
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-3300
  • Fax:
Mailing address:
  • Phone: 330-666-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number09205216
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: