Provider Demographics
NPI:1528277449
Name:HIGGINS, KELLY JO (RPH)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:HIGGINS
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 1:2211 11TH ST. E.
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336
Mailing Address - Country:US
Mailing Address - Phone:320-864-5192
Mailing Address - Fax:320-864-2767
Practice Address - Street 1:2211 11TH ST. E.
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336
Practice Address - Country:US
Practice Address - Phone:320-864-5192
Practice Address - Fax:320-864-2767
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist