Provider Demographics
NPI:1225064090
Name:WIGGINS, ROBERT LLOYD (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LLOYD
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6099
Mailing Address - Country:US
Mailing Address - Phone:423-753-0148
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF SIDNEY AND LAMONT ST
Practice Address - Street 2:JAMES H. QUILLEN/VA MEDICAL CENTER
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029014-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist