Provider Demographics
NPI:1528780632
Name:HIGGINS, MYKELA LINNEA (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:MYKELA
Middle Name:LINNEA
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-4263
Mailing Address - Country:US
Mailing Address - Phone:401-737-2305
Mailing Address - Fax:
Practice Address - Street 1:2400 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-4263
Practice Address - Country:US
Practice Address - Phone:401-737-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist