Provider Demographics
NPI:1447529524
Name:RIGGINS, PEGGY ANN
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:RIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 53RD ST UNIT 612S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4380
Mailing Address - Country:US
Mailing Address - Phone:773-667-1886
Mailing Address - Fax:
Practice Address - Street 1:11 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1601
Practice Address - Country:US
Practice Address - Phone:773-224-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist