Individual
MR. KENNERH PROVINE COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
E7052
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E7052
MISSISSIPPI PHARMACY LICENSE
MS
Enumeration date
06/10/2013
Last updated
06/10/2013
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