Provider Demographics
NPI:1205655909
Name:HIGGINS, DONOVAN
Entity type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3213
Mailing Address - Country:US
Mailing Address - Phone:317-249-8572
Mailing Address - Fax:
Practice Address - Street 1:2140 E 116TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3213
Practice Address - Country:US
Practice Address - Phone:317-249-8572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024797A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist