Provider Demographics
NPI:1285681783
Name:HIGH PHARMACY INC
Entity Type:Organization
Organization Name:HIGH PHARMACY INC
Other - Org Name:HIGH PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERLINO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:617-242-0415
Mailing Address - Street 1:54 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3317
Mailing Address - Country:US
Mailing Address - Phone:617-242-0415
Mailing Address - Fax:617-242-2521
Practice Address - Street 1:54 HIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3317
Practice Address - Country:US
Practice Address - Phone:617-242-0415
Practice Address - Fax:617-242-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MA39993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2038596OtherPK
MA110020879AMedicaid
5061020001Medicare NSC