Individual
DR. GWENESIA S COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
17060 MASONIC, SUITE 107, FRASER, MI 48026-2561
(586) 293-0500
(586) 293-0501
Mailing address
17060 MASONIC STE 107, FRASER, MI 48026-2561
(586) 293-0500
(586) 293-0501
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5301008165
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01809
BCBS DME PROVIDER ID
MI
01
—
01882
BCBS PROVIDER ID
MI
05
—
2367363
—
MI
Enumeration date
03/13/2007
Last updated
07/09/2007
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