Provider Demographics
NPI:1912254616
Name:HIGGINS, WILLIE JAMES (DPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:JAMES
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 COONROD AVE
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-3290
Mailing Address - Country:US
Mailing Address - Phone:918-865-2164
Mailing Address - Fax:918-865-7933
Practice Address - Street 1:124 COONROD AVE
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044-3290
Practice Address - Country:US
Practice Address - Phone:918-865-2164
Practice Address - Fax:918-865-7933
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist