Provider Demographics
NPI:1588946859
Name:COLLINS, RICHARD VANHALEN II (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VANHALEN
Last Name:COLLINS
Suffix:II
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:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-1175
Mailing Address - Country:US
Mailing Address - Phone:530-546-2523
Mailing Address - Fax:530-546-7093
Practice Address - Street 1:8245 NORTH LAKE BLV
Practice Address - Street 2:
Practice Address - City:KINGS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143
Practice Address - Country:US
Practice Address - Phone:530-546-2523
Practice Address - Fax:530-546-7093
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist