Provider Demographics
NPI:1598360539
Name:WIGGINTON, ZACHARY (RPH)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:WIGGINTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 ROBERT C DANIEL JR PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0800
Mailing Address - Country:US
Mailing Address - Phone:706-733-3011
Mailing Address - Fax:
Practice Address - Street 1:235 ROBERT C DANIEL JR PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0800
Practice Address - Country:US
Practice Address - Phone:706-733-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist