Provider Demographics
NPI:1598785610
Name:WIGGINS, MICHAEL GREGG JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GREGG
Last Name:WIGGINS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:PINK HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28572-0609
Mailing Address - Country:US
Mailing Address - Phone:252-568-3161
Mailing Address - Fax:252-568-2339
Practice Address - Street 1:107 WEST BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:PINK HILL
Practice Address - State:NC
Practice Address - Zip Code:28572
Practice Address - Country:US
Practice Address - Phone:252-568-3161
Practice Address - Fax:252-568-2339
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist