Provider Demographics
NPI:1306113378
Name:COLLIER, SIDNEY BOYD III (PHARM D)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:BOYD
Last Name:COLLIER
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 MALLARD RUN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-6354
Mailing Address - Country:US
Mailing Address - Phone:678-881-9808
Mailing Address - Fax:
Practice Address - Street 1:6111 HICKORY FLAT HIGHWAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115
Practice Address - Country:US
Practice Address - Phone:770-479-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist