Healthcare Provider Details

I. General information

NPI: 1598785610
Provider Name (Legal Business Name): MICHAEL GREGG WIGGINS JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WEST BROADWAY STREET
PINK HILL NC
28572
US

IV. Provider business mailing address

PO BOX 609
PINK HILL NC
28572-0609
US

V. Phone/Fax

Practice location:
  • Phone: 252-568-3161
  • Fax: 252-568-2339
Mailing address:
  • Phone: 252-568-3161
  • Fax: 252-568-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14416
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: