Provider Demographics
NPI:1386889491
Name:HIGHLAND PHARMACY LLC
Entity type:Organization
Organization Name:HIGHLAND PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:248-977-1394
Mailing Address - Street 1:4000 HIGHLAND RD
Mailing Address - Street 2:SUITE#113
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2167
Mailing Address - Country:US
Mailing Address - Phone:248-977-1394
Mailing Address - Fax:248-977-1395
Practice Address - Street 1:4000 HIGHLAND RD
Practice Address - Street 2:SUITE#113
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2167
Practice Address - Country:US
Practice Address - Phone:248-977-1394
Practice Address - Fax:248-977-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315038823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty