=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649344748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGGINS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 395 PARK AVE
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44001-2233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-988-4366
-----------------------------------------------------
Fax | 440-988-3100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 395 PARK AVE
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44001-2233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-988-4366
-----------------------------------------------------
Fax | 440-988-3100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. EDWARD C HIGGINS
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 440-988-4366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------