Provider Demographics
NPI:1316031727
Name:HIGH GROUNDS PHARMACY
Entity Type:Organization
Organization Name:HIGH GROUNDS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARM
Authorized Official - Prefix:
Authorized Official - First Name:JAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-527-1112
Mailing Address - Street 1:638 BAYWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-2613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:638 BAYWAY AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-2613
Practice Address - Country:US
Practice Address - Phone:908-527-1112
Practice Address - Fax:908-527-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NJ333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0084191Medicaid
3192313OtherOTHER ID NUMBER-COMMERCIAL NUMBER