Individual
COLLIN LAFAYETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1617 JFK BLVD, PHILADELPHIA, PA 19103-1821
(215) 561-1316
Mailing address
1617 JFK BLVD, PHILADELPHIA, PA 19103-1821
(215) 561-1316
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP449819
PA
Other
Enumeration date
07/25/2016
Last updated
07/25/2016
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