Provider Demographics
NPI:1154620763
Name:WIGGINS, KATRINA (RPH)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CHAD ST SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-4607
Mailing Address - Country:US
Mailing Address - Phone:706-602-2166
Mailing Address - Fax:706-602-3723
Practice Address - Street 1:206 CHAD ST SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-4607
Practice Address - Country:US
Practice Address - Phone:706-602-2166
Practice Address - Fax:706-602-3723
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist