Provider Demographics
NPI:1740312859
Name:HIGGINS, TYLER CARL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:CARL
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 BIG CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8058
Mailing Address - Country:US
Mailing Address - Phone:208-467-1335
Mailing Address - Fax:208-459-1504
Practice Address - Street 1:315 E ELM ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4857
Practice Address - Country:US
Practice Address - Phone:208-459-1503
Practice Address - Fax:208-459-1504
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist