Provider Demographics
NPI:1083755714
Name:WIGGINS DRUGS LIMITED
Entity Type:Organization
Organization Name:WIGGINS DRUGS LIMITED
Other - Org Name:KING HOME CARE POWDERLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D RPH
Authorized Official - Phone:270-298-0259
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0145
Mailing Address - Country:US
Mailing Address - Phone:270-298-0259
Mailing Address - Fax:270-298-7641
Practice Address - Street 1:2227 W EVERLY BROS BLVD
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5405
Practice Address - Country:US
Practice Address - Phone:270-338-7738
Practice Address - Fax:270-338-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYHME00235332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1829932OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY90013426OtherMEDICAID
KY5540130007Medicare NSC