Provider Demographics
NPI:1508994260
Name:ROBERT HIGGINBOTTOM
Entity Type:Organization
Organization Name:ROBERT HIGGINBOTTOM
Other - Org Name:THE PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BO
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINBOTTOM
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:731-925-3956
Mailing Address - Street 1:765 FLORENCE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-5219
Mailing Address - Country:US
Mailing Address - Phone:731-925-3956
Mailing Address - Fax:
Practice Address - Street 1:765 FLORENCE RD STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-5219
Practice Address - Country:US
Practice Address - Phone:731-925-3956
Practice Address - Fax:731-925-8754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN11013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2096000OtherPK
TN3538186Medicaid
TN3538186Medicaid
2096000OtherPK