Provider Demographics
NPI:1750488920
Name:WIGGINS, LANE D (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LANE
Middle Name:D
Last Name:WIGGINS
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 1:16800 DEAVOURS DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-2690
Mailing Address - Country:US
Mailing Address - Phone:205-330-0971
Mailing Address - Fax:205-333-0924
Practice Address - Street 1:13620 HIGHWAY 43 N
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-4411
Practice Address - Country:US
Practice Address - Phone:205-333-0678
Practice Address - Fax:205-333-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist