Healthcare Provider Details

I. General information

NPI: 1295191633
Provider Name (Legal Business Name): DAVID HIGDON JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2782 N COBB PKWY
KENNESAW GA
30152-3472
US

IV. Provider business mailing address

PO BOX 671342
MARIETTA GA
30066-0140
US

V. Phone/Fax

Practice location:
  • Phone: 770-420-1092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH016329
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34569
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: