Krystan Collins
Individual provider Active NPI Pharmacist · Shiloh, IL
NPI 1417765769 · NPPES record last updated Dec 19, 2024
Key facts
- NPI
- 1417765769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.306824 (IL)
- Practice address
- 3400 Green Mount Crossing Dr
Shiloh, IL 62269-7277 - Phone
- (618) 628-3334
- NPI assigned
- Dec 19, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 051.306824 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.306824 | IL | Yes |
Addresses
Primary practice location
3400 Green Mount Crossing Dr
Shiloh, IL 62269-7277
Mailing address
647 Troy Rd
Collinsville, IL 62234-5566
Phone (618) 741-0670
Other providers in Shiloh, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2024. 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.