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General NPI Number Information
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NPI Number | 1770698557
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Entity Type | Organization
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Legal Business Name | COLLINS FAMILY MARKETS, INC.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 5675 N FRONT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19120
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Country | US
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Telephone | 215-224-7505
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Fax | 215-224-8329
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Provider Business Mailing Address
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Address Line | 5675 N FRONT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19120
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THIRD PARTY ADMINISTRATOR
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Name | MELISSA FIGUEROA RIVERA
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Credential |
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Telephone | 732-521-8439
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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 | PP414003L
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License Number State | PA
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