Provider Demographics
NPI:1407270044
Name:WIGGINTON, RITA DIANE (RPH, PHARMD, MHA)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:DIANE
Last Name:WIGGINTON
Suffix:
Gender:F
Credentials:RPH, PHARMD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 GREENLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1608
Mailing Address - Country:US
Mailing Address - Phone:270-791-9148
Mailing Address - Fax:
Practice Address - Street 1:600 US 31W BYP STE 12
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4905
Practice Address - Country:US
Practice Address - Phone:270-782-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38062183500000X
KY016248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist