Provider Demographics
NPI:1457169948
Name:COLLINS RX LLC
Entity type:Organization
Organization Name:COLLINS RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAHATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KANKANALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-720-5552
Mailing Address - Street 1:2160 N COLLINS ST # 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2877
Mailing Address - Country:US
Mailing Address - Phone:469-307-6162
Mailing Address - Fax:817-720-5553
Practice Address - Street 1:2160 N COLLINS ST # 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2877
Practice Address - Country:US
Practice Address - Phone:469-307-6162
Practice Address - Fax:817-720-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center