Provider Demographics
NPI:1053913871
Name:COLLINS, STEVEN BRANDON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRANDON
Last Name:COLLINS
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 1:241 GATEWAY PLZ STE 105
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3350
Mailing Address - Country:US
Mailing Address - Phone:276-386-6644
Mailing Address - Fax:
Practice Address - Street 1:241 GATEWAY PLZ STE 105
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3350
Practice Address - Country:US
Practice Address - Phone:276-386-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37145183500000X
VA0202210693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist