Provider Demographics
NPI:1962410118
Name:HIGGINS, BRYON CHARLES (RPH)
Entity type:Individual
Prefix:MR
First Name:BRYON
Middle Name:CHARLES
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8387 BELLE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8954
Mailing Address - Country:US
Mailing Address - Phone:810-694-0657
Mailing Address - Fax:800-651-2060
Practice Address - Street 1:8387 BELLE BLUFF DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8954
Practice Address - Country:US
Practice Address - Phone:810-694-0657
Practice Address - Fax:800-651-2060
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist