Provider Demographics
NPI:1154922565
Name:HIGGS, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:BRENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 LLOYD LN
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:AR
Mailing Address - Zip Code:72847-7007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2409 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9619
Practice Address - Country:US
Practice Address - Phone:479-968-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist