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General NPI Number Information
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NPI Number | 1316549272
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Entity Type | Individual
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Provider Name | DIANE NELSON COLLINS
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Gender | Female
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Dates
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Enumeration Date | 11/14/2020
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Last Update Date | 11/14/2020
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Provider Practice Location Address
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Address Line | 100 BUCKHANNON XRDS
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City | BUCKHANNON
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State | WV
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Zip | 26201-8422
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Country | US
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Telephone | 304-472-0834
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Fax |
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Provider Business Mailing Address
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Address Line | 3285 HOLLY GROVE RD
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City | ROCK CAVE
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State | WV
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Zip | 26234-5715
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Country | US
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Telephone | 304-924-5610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP002871
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License Number State | WV
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