Provider Demographics
NPI:1558506451
Name:HIGHLAND PHARMACY LLC
Entity Type:Organization
Organization Name:HIGHLAND PHARMACY LLC
Other - Org Name:HIGHLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-977-1394
Mailing Address - Street 1:4000 HIGHLAND RD
Mailing Address - Street 2:STE 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:STE 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:2008-12-05
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301009009261QI0500X, 261QM1300X, 332B00000X, 3336C0003X
3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6030654Medicaid
2118084OtherPK
6727960001Medicare NSC