Healthcare Provider Details

I. General information

NPI: 1306157151
Provider Name (Legal Business Name): SCOTT ROBERT KOLLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WARREN AVE RITE AID #10256
EAST PROVIDENCE RI
02914-1404
US

IV. Provider business mailing address

655 WARREN AVE RITE AID #10256
EAST PROVIDENCE RI
02914-1404
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-5700
  • Fax: 401-438-5639
Mailing address:
  • Phone: 401-434-5700
  • Fax: 401-438-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23073
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03831
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: