Provider Demographics
NPI:1649344748
Name:HIGGINS PHARMACY INC
Entity type:Organization
Organization Name:HIGGINS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:440-988-4366
Mailing Address - Street 1:395 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2233
Mailing Address - Country:US
Mailing Address - Phone:440-988-4366
Mailing Address - Fax:440-988-3100
Practice Address - Street 1:395 PARK AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2233
Practice Address - Country:US
Practice Address - Phone:440-988-4366
Practice Address - Fax:440-988-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5115502Medicaid
OH3612365OtherNCPDP NABP #
OHAH2959180OtherDEA #
OH0150350001Medicare ID - Type Unspecified