Provider Demographics
NPI:1679833404
Name:HIGHLAND SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:HIGHLAND SPECIALTY PHARMACY LLC
Other - Org Name:HIGHLAND SPECIALTY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-268-6033
Mailing Address - Street 1:10 C AINSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1869
Mailing Address - Country:US
Mailing Address - Phone:601-268-6033
Mailing Address - Fax:601-268-6690
Practice Address - Street 1:10 C AINSWORTH DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1869
Practice Address - Country:US
Practice Address - Phone:601-268-6033
Practice Address - Fax:601-268-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF114033336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2588842OtherNCPDP PROVIDER IDENTIFICATION NUMBER