Provider Demographics
NPI:1932262227
Name:DOUGLAS C. HIGGINS
Entity Type:Organization
Organization Name:DOUGLAS C. HIGGINS
Other - Org Name:DOUG'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:217-379-3684
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3904160001Medicare ID - Type Unspecified