MEDICARE: MR. MICHAEL RODGERS COLLIER DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH025308	GA
2	183500000X	Pharmacist	5584	TN
3	183500000X	Pharmacist	PS36445	FL

General Provider Information

NPI Number	:	1134473739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL RODGERS COLLIER DPH

Provider Business Mailing Address
First Line	:	3313 LOCKWOOD DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-5205
Country	:	US
Telephone Number	:	423-877-5226
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3849
Country	:	US
Telephone Number	:	706-861-2771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2012
Last Update Date	:	11/04/2012

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