Provider Demographics
NPI:1164103891
Name:HIGGINS, MILEJAH DIANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MILEJAH
Middle Name:DIANE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 SANDIDGE CENTER CV STE A
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3574
Mailing Address - Country:US
Mailing Address - Phone:662-892-8448
Mailing Address - Fax:662-892-8189
Practice Address - Street 1:9065 SANDIDGE CENTER CV STE A
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3574
Practice Address - Country:US
Practice Address - Phone:662-892-8448
Practice Address - Fax:662-892-8189
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist