MEDICARE: COLLINS RX LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1982365748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLINS RX LLC

Provider Business Mailing Address
First Line	:	2160 N COLLINS ST STE 120
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2877
Country	:	US
Telephone Number	:	469-307-6162
Fax Number	:

Provider Business Practice Location Address
First Line	:	2160 N COLLINS ST STE 120
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2877
Country	:	US
Telephone Number	:	469-307-6162
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. MAHATHI KANKANALA
Credential	:	PHARM D
Telephone Number	:	469-307-6162

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	06/20/2023

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Directions to “COLLINS RX LLC ” Practice Location

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