Provider Demographics
NPI:1407229149
Name:HIGGINS, RANDALL T (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:T
Last Name:HIGGINS
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 1:17 WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1817
Mailing Address - Country:US
Mailing Address - Phone:732-895-6172
Mailing Address - Fax:
Practice Address - Street 1:17 WAVERLY PL
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1817
Practice Address - Country:US
Practice Address - Phone:732-895-6172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03542700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist