Provider Demographics
NPI:1891809877
Name:HIGHLAND PARK PHARMACY INC
Entity Type:Organization
Organization Name:HIGHLAND PARK PHARMACY INC
Other - Org Name:HIGHLAND PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:785-234-6688
Mailing Address - Street 1:1244 SE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-1414
Mailing Address - Country:US
Mailing Address - Phone:785-234-6688
Mailing Address - Fax:785-234-9251
Practice Address - Street 1:1244 SE 27TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-1414
Practice Address - Country:US
Practice Address - Phone:785-234-6688
Practice Address - Fax:785-234-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336L0003X
KS2-061543336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100438180AMedicaid
2031221OtherPK
0729540001Medicare NSC