Healthcare Provider Details

I. General information

NPI: 1023644390
Provider Name (Legal Business Name): DR. BRIAN JAMES COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 LOUISIANA AVE
PERRYSBURG OH
43551-2537
US

IV. Provider business mailing address

1131 CEDAR CREEK DR
NORTHWOOD OH
43619-2656
US

V. Phone/Fax

Practice location:
  • Phone: 419-874-3587
  • Fax:
Mailing address:
  • Phone: 419-349-8165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: