Healthcare Provider Details

I. General information

NPI: 1669555421
Provider Name (Legal Business Name): ROBERT JOSEPH WIGGINS JR. RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY & WOODLAND AVENUE
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

49 LAS BRISAS BLVD
VOORHEES NJ
08043-3421
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-6365
  • Fax:
Mailing address:
  • Phone: 856-282-7493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02796700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: