Provider Demographics
NPI:1760219331
Name:RIGGS, JERRY DAN (RPH)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:DAN
Last Name:RIGGS
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 1:179 SILVERADO
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2326
Mailing Address - Country:US
Mailing Address - Phone:830-660-6104
Mailing Address - Fax:830-964-4429
Practice Address - Street 1:179 SILVERADO
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-2326
Practice Address - Country:US
Practice Address - Phone:830-660-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist