MEDICARE: MACHE HIGGASON

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	183500000X	Pharmacist	E8769	MS

General Provider Information

NPI Number	:	1962710244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACHE HIGGASON

Provider Business Mailing Address
First Line	:	813 W PARK AVE
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38930-2824
Country	:	US
Telephone Number	:	662-455-3527
Fax Number	:	662-455-2142

Provider Business Practice Location Address
First Line	:	813 W PARK AVE
Second Line	:
City	:	GREENWOOD
State	:	MS
Zip	:	38930-2824
Country	:	US
Telephone Number	:	662-455-3527
Fax Number	:	662-455-2142

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

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	09/20/2010

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Directions to “ MACHE HIGGASON ” Practice Location

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