Provider Demographics
NPI:1699967059
Name:COLLINS, CHARLES HUGH JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HUGH
Last Name:COLLINS
Suffix:JR
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 1:1833 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-4394
Mailing Address - Country:US
Mailing Address - Phone:904-232-2751
Mailing Address - Fax:904-232-1570
Practice Address - Street 1:1833 BOULEVARD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4394
Practice Address - Country:US
Practice Address - Phone:904-232-2751
Practice Address - Fax:904-232-1570
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist