Provider Demographics
NPI:1427114651
Name:EAGLE HIGHLAND PHARMACY INC
Entity type:Organization
Organization Name:EAGLE HIGHLAND PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:317-299-3771
Mailing Address - Street 1:9010 CRAWFORDSVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234
Mailing Address - Country:US
Mailing Address - Phone:317-299-3771
Mailing Address - Fax:866-828-4069
Practice Address - Street 1:9010 CRAWFORDSVILLE RD.
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234
Practice Address - Country:US
Practice Address - Phone:317-299-3771
Practice Address - Fax:866-828-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN600036133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100292870AMedicaid
1524479OtherNABP
IN100292870AMedicaid