Provider Demographics
NPI:1114027414
Name:HIGHLANDER PHARMACY LLC
Entity Type:Organization
Organization Name:HIGHLANDER PHARMACY LLC
Other - Org Name:CYPRESS POINT RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, PHARMACY LICENSING/CONTRAC
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISKIMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-572-0009
Mailing Address - Street 1:5500 E LOOP 820 S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-6569
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-720-1039
Practice Address - Street 1:2225 VATICAN LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4719
Practice Address - Country:US
Practice Address - Phone:817-375-2036
Practice Address - Fax:214-467-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300163336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153493OtherPK
TX145418Medicaid