Provider Demographics
NPI:1194328039
Name:WIGGINS, CHAD E (PHARMD)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:E
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 S. MARGARET AVE
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75956
Mailing Address - Country:US
Mailing Address - Phone:409-423-2215
Mailing Address - Fax:409-423-2267
Practice Address - Street 1:1606 S. MARGARET AVE
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75956
Practice Address - Country:US
Practice Address - Phone:409-423-2215
Practice Address - Fax:409-423-2267
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist