Provider Demographics
NPI:1457739278
Name:WIGGINS ENTERPRISE LLC
Entity Type:Organization
Organization Name:WIGGINS ENTERPRISE LLC
Other - Org Name:XPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:LANTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-541-3300
Mailing Address - Street 1:7555 BELLAIRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5055
Mailing Address - Country:US
Mailing Address - Phone:713-541-3300
Mailing Address - Fax:713-541-3301
Practice Address - Street 1:7555 BELLAIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5055
Practice Address - Country:US
Practice Address - Phone:713-541-3300
Practice Address - Fax:713-541-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX298603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151865OtherPK