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General NPI Number Information
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NPI Number | 1134874217
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Entity Type | Organization
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Legal Business Name | COLLIERVILLE HEALTHCARE CORP
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 2130 W POPLAR AVE STE 104
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0615
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Country | US
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Telephone | 901-542-8001
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Fax | 901-542-8002
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Provider Business Mailing Address
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Address Line | 2130 W POPLAR AVE STE 104
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0615
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Country | US
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Telephone | 901-542-8001
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Fax | 901-542-8002
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Authorized Official
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Title or Position | OWNER
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Name | DARSHAN PATEL
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Credential |
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Telephone | 901-542-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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