MEDICARE: JENNIFER REID COLLINS PHARMD.

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	26025021A	IN

General Provider Information

NPI Number	:	1538500061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER REID COLLINS PHARMD.

Provider Business Mailing Address
First Line	:	1011 MAIN ST
Second Line	:	SUITE 110
City	:	SPEEDWAY
State	:	IN
Zip	:	46224-6977
Country	:	US
Telephone Number	:	317-957-9062
Fax Number	:	317-957-9952

Provider Business Practice Location Address
First Line	:	1011 MAIN ST
Second Line	:	SUITE 110
City	:	SPEEDWAY
State	:	IN
Zip	:	46224-6977
Country	:	US
Telephone Number	:	317-957-9062
Fax Number	:	317-957-9952

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

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	08/14/2015

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