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General NPI Number Information
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NPI Number | 1508418112
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Entity Type | Individual
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Provider Name | IESHA M COLLA PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2019
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 11343 US HIGHWAY 319 N
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City | THOMASVILLE
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State | GA
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Zip | 31757-3419
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Country | US
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Telephone | 229-226-5424
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Fax | 229-226-5048
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Provider Business Mailing Address
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Address Line | PO BOX 971
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City | OPELOUSAS
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State | LA
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Zip | 70571-0971
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Country | US
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Telephone | 337-692-1840
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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 | RPH031263
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License Number State | GA
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