Healthcare Provider Details

I. General information

NPI: 1194328039
Provider Name (Legal Business Name): CHAD E WIGGINS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 S. MARGARET AVE
KIRBYVILLE TX
75956
US

IV. Provider business mailing address

1606 S. MARGARET AVE
KIRBYVILLE TX
75956
US

V. Phone/Fax

Practice location:
  • Phone: 409-423-2215
  • Fax: 409-423-2267
Mailing address:
  • Phone: 409-423-2215
  • Fax: 409-423-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: