Provider Demographics
NPI:1386318814
Name:WRIGHT, COLLIN LANCE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:LANCE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CLIFTON AVE
Mailing Address - Street 2:PO BOX 745
Mailing Address - City:MONTEZUMA
Mailing Address - State:KS
Mailing Address - Zip Code:67867-0745
Mailing Address - Country:US
Mailing Address - Phone:620-846-0563
Mailing Address - Fax:
Practice Address - Street 1:300 N AZTEC ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:KS
Practice Address - Zip Code:67867-8874
Practice Address - Country:US
Practice Address - Phone:620-846-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-103719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist