MEDICARE: DENISE HIGGINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	NOT REGULATED	VA

General Provider Information

NPI Number	:	1912398330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE HIGGINS

Provider Business Mailing Address
First Line	:	2905 DISTRICT AVE S
Second Line	:	400
City	:	FAIRFAX
State	:	VA
Zip	:	22031
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 DISTRICT AVE S
Second Line	:	400
City	:	FAIRFAX
State	:	VA
Zip	:	22031
Country	:	US
Telephone Number	:	571-533-3751
Fax Number	:	571-533-3762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	02/06/2015

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