Healthcare Provider Details

I. General information

NPI: 1700148558
Provider Name (Legal Business Name): ANTHONY J COLLINS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTHONY J AMENDOLIA JR.

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 SW H K DODGEN LOOP
TEMPLE TX
76502-1814
US

IV. Provider business mailing address

1105 DRY RIDGE RD
HARKER HEIGHTS TX
76548-7168
US

V. Phone/Fax

Practice location:
  • Phone: 254-778-1731
  • Fax: 254-791-2266
Mailing address:
  • Phone: 267-254-4817
  • Fax: 254-791-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPI000841
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP439479
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: