Provider Demographics
NPI:1306157151
Name:KOLLAR, SCOTT ROBERT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROBERT
Last Name:KOLLAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 WARREN AVE
Mailing Address - Street 2:RITE AID #10256
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1404
Mailing Address - Country:US
Mailing Address - Phone:401-434-5700
Mailing Address - Fax:401-438-5639
Practice Address - Street 1:655 WARREN AVE
Practice Address - Street 2:RITE AID #10256
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1404
Practice Address - Country:US
Practice Address - Phone:401-434-5700
Practice Address - Fax:401-438-5639
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23073183500000X
RI03831183500000X
AZ11149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist