Provider Demographics
NPI:1396406443
Name:HIGGINS, ASHLEY MARY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARY
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 1:3310 CHERRYVALE AVE APT 64
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8794
Mailing Address - Country:US
Mailing Address - Phone:218-481-5578
Mailing Address - Fax:
Practice Address - Street 1:2050 LIME KILN RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6264
Practice Address - Country:US
Practice Address - Phone:920-406-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21204-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist