Provider Demographics
NPI:1306243175
Name:COLLIER, SHAUNA (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:COLLIER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 POPLAR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-5655
Mailing Address - Country:US
Mailing Address - Phone:843-813-6294
Mailing Address - Fax:
Practice Address - Street 1:46 POPLAR VIEW DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-5655
Practice Address - Country:US
Practice Address - Phone:843-813-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-22
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15489183500000X
VA0202210969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist