Provider Demographics
NPI:1194268672
Name:COLLINS, MARCIA (RPH)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:ANITA
Other - Last Name:JESPERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4415 SAYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3478
Mailing Address - Country:US
Mailing Address - Phone:717-919-8065
Mailing Address - Fax:
Practice Address - Street 1:4415 SAYBROOK LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3478
Practice Address - Country:US
Practice Address - Phone:717-919-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP03310L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist