Provider Demographics
NPI:1063701944
Name:HIGHLAWN PREFERRED PHARMACY
Entity type:Organization
Organization Name:HIGHLAWN PREFERRED PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BAFFOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:AGYARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-522-6304
Mailing Address - Street 1:2828 1ST AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-522-6304
Mailing Address - Fax:304-522-6399
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-522-6304
Practice Address - Fax:304-522-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05524153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5055442OtherNCPDP PROVIDER IDENTIFICATION NUMBER