Provider Demographics
NPI:1295724789
Name:RIGGINS, EPHRAIM NMN (RPH,CPH,PHARMD)
Entity type:Individual
Prefix:DR
First Name:EPHRAIM
Middle Name:NMN
Last Name:RIGGINS
Suffix:
Gender:M
Credentials:RPH,CPH,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12754 SHINNECOCK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4692
Mailing Address - Country:US
Mailing Address - Phone:904-642-1906
Mailing Address - Fax:904-470-6901
Practice Address - Street 1:6900 SOUTHPOINT DR N
Practice Address - Street 2:FOURTH FLOOR VA OUTPATIENT CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8007
Practice Address - Country:US
Practice Address - Phone:904-470-6900
Practice Address - Fax:904-470-6901
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist