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General NPI Number Information
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NPI Number | 1508994260
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Entity Type | Organization
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Legal Business Name | ROBERT HIGGINBOTTOM
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 765 FLORENCE RD STE B
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City | SAVANNAH
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State | TN
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Zip | 38372-5219
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Country | US
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Telephone | 731-925-3956
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Fax | 731-925-8754
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Provider Business Mailing Address
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Address Line | 765 FLORENCE RD STE B
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City | SAVANNAH
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State | TN
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Zip | 38372-5219
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Country | US
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Telephone | 731-925-3956
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BO HIGGINBOTTOM
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Credential | DPH
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Telephone | 731-925-3956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1101
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License Number State | TN
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