Provider Demographics
NPI:1376558973
Name:HIGGINS PHARMACY INC
Entity Type:Organization
Organization Name:HIGGINS PHARMACY INC
Other - Org Name:HIGGINS PHARMACY INC INSTITUTIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:440-988-4366
Mailing Address - Street 1:395 PARK AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:395 PARK AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2233
Practice Address - Country:US
Practice Address - Phone:440-988-4366
Practice Address - Fax:440-988-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X, 3336M0003X
OH3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3643853OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH5115502Medicaid
3643853OtherOTHER ID NUMBER
0150350001Medicare NSC