Provider Demographics
NPI:1619018348
Name:WIGGINS DRUGS LIMITED
Entity Type:Organization
Organization Name:WIGGINS DRUGS LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM RPH
Authorized Official - Phone:270-298-0259
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0145
Mailing Address - Country:US
Mailing Address - Phone:270-298-0259
Mailing Address - Fax:270-298-7641
Practice Address - Street 1:1405 NASHVILLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8850
Practice Address - Country:US
Practice Address - Phone:270-725-9027
Practice Address - Fax:270-725-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYHME00236332B00000X
KYPO74153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1829956OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY90013442OtherMEDICAID - DME
1829956OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY5540130005Medicare NSC