Provider Demographics
NPI:1770524357
Name:HIGGINS, DOUGLAS CHARLES (R PH)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-1221
Mailing Address - Country:US
Mailing Address - Phone:217-379-3684
Mailing Address - Fax:217-379-6115
Practice Address - Street 1:137 N MARKET ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-1221
Practice Address - Country:US
Practice Address - Phone:217-379-3684
Practice Address - Fax:217-379-6115
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3904160001Medicare ID - Type Unspecified