Provider Demographics
NPI:1871876185
Name:WIGGETMAN, ALAN P (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:P
Last Name:WIGGETMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5351
Mailing Address - Country:US
Mailing Address - Phone:702-228-2480
Mailing Address - Fax:702-228-8589
Practice Address - Street 1:9300 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5351
Practice Address - Country:US
Practice Address - Phone:702-228-2480
Practice Address - Fax:702-228-8589
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist