MEDICARE: KENNETH P COLLINS RPH

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	RP042884T	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP042884T	OTHER	PA	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE

General Provider Information

NPI Number	:	1588130736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH P COLLINS RPH

Provider Business Mailing Address
First Line	:	106 JASON DR
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16002-9086
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 JASON DR
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16002-9086
Country	:	US
Telephone Number	:	724-360-0008
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	10/15/2018

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Directions to “ KENNETH P COLLINS RPH” Practice Location

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