Healthcare Provider Details

I. General information

NPI: 1013005271
Provider Name (Legal Business Name): MICHAEL EDWARD COLLETT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BRECKSVILLE RD
BRECKSVILLE OH
44141-3204
US

IV. Provider business mailing address

9606 TROY CT
MENTOR OH
44060-7468
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-2020
  • Fax:
Mailing address:
  • Phone: 440-526-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number03-2-11394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: