1366484826 NPI number — WIGGINS DRUGS LIMITED

Table of content: (NPI 1366484826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366484826 NPI number — WIGGINS DRUGS LIMITED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIGGINS DRUGS LIMITED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KING DRUG & HOME CARE - HARTFORD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366484826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42347-0145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-298-0259
Provider Business Mailing Address Fax Number:
270-298-7641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1014 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42347-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-298-3278
Provider Business Practice Location Address Fax Number:
270-298-3290
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIGGINS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER/OWNER/ADMINISTRATO
Authorized Official Telephone Number:
270-298-0259

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PO7045 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: HME00228 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: P07045 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PO7045 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1805095 . This is a "NCPDP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 54010707 . This is a "MEDICAID-PHARMACY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 90013517 . This is a "MEDICAID-DME" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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