Provider Demographics
NPI:1346843166
Name:HIGGINS, JOSEPH LEO (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEO
Last Name:HIGGINS
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 1:11 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379
Mailing Address - Country:US
Mailing Address - Phone:860-287-5036
Mailing Address - Fax:
Practice Address - Street 1:155 WATERFORD PKWY N
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1208
Practice Address - Country:US
Practice Address - Phone:860-447-3747
Practice Address - Fax:860-447-8981
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist