Marisa Collins
Individual provider Active NPI Pharmacist · Glennville, GA
NPI 1053968339 · NPPES record last updated Aug 21, 2019
Key facts
- NPI
- 1053968339
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH031633 (GA)
- Practice address
- 402 S Veterans Blvd
Glennville, GA 30427-1772 - Phone
- (912) 654-9647
- NPI assigned
- Aug 21, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH031633 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH031633 | GA | Yes |
Addresses
Primary practice location
402 S Veterans Blvd
Glennville, GA 30427-1772
Mailing address
587 Murphy Cir
Collins, GA 30421-4438
Other providers in Glennville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.