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General NPI Number Information
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NPI Number | 1669010906
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Entity Type | Individual
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Provider Name | JASON COLLINS
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Gender | Male
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 4701 HIGHWAY 101
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City | FLORENCE
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State | OR
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Zip | 97439-8807
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Country | US
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Telephone | 541-902-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 15TH AVE SW
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City | ALBANY
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State | OR
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Zip | 97321-2111
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Country | US
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Telephone | 541-570-0089
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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 | RPH-0017429
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH-0017429
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License Number State | OR
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