Provider Demographics
NPI:1346473840
Name:WIGINTON, ROBERT LANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LANE
Last Name:WIGINTON
Suffix:
Gender:M
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:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040
Mailing Address - Country:US
Mailing Address - Phone:866-229-7389
Mailing Address - Fax:303-372-6220
Practice Address - Street 1:2103 VETERANS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:866-229-7389
Practice Address - Fax:303-372-6220
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist