Provider Demographics
NPI:1609869817
Name:WIGANS, GWEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:
Last Name:WIGANS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3353
Mailing Address - Country:US
Mailing Address - Phone:563-264-2572
Mailing Address - Fax:
Practice Address - Street 1:315 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4109
Practice Address - Country:US
Practice Address - Phone:563-263-7044
Practice Address - Fax:563-263-5941
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist