Healthcare Provider Details

I. General information

NPI: 1700780301
Provider Name (Legal Business Name): KORDELL LESHON COLLINS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SHUCKER CIR APT 310
MOUNT PLEASANT SC
29464-4946
US

IV. Provider business mailing address

1401 SHUCKER CIR APT 310
MOUNT PLEASANT SC
29464-4946
US

V. Phone/Fax

Practice location:
  • Phone: 814-251-5430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH.68019
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: