Provider Demographics
NPI:1871609925
Name:COLLIER, CARL MELVIN (RPH PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:MELVIN
Last Name:COLLIER
Suffix:
Gender:M
Credentials:RPH PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 E MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2727
Mailing Address - Country:US
Mailing Address - Phone:479-521-4323
Mailing Address - Fax:479-443-2111
Practice Address - Street 1:100 WEST DICKSON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-442-6262
Practice Address - Fax:479-587-0889
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist