Provider Demographics
NPI:1912150897
Name:HIGHLAND PHARMACY LLC
Entity Type:Organization
Organization Name:HIGHLAND PHARMACY LLC
Other - Org Name:HIGHLAND PHARMACY & COFFEE CAFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-935-6900
Mailing Address - Street 1:67 POPLAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2808
Mailing Address - Country:US
Mailing Address - Phone:706-935-6900
Mailing Address - Fax:706-935-6929
Practice Address - Street 1:67 POPLAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2808
Practice Address - Country:US
Practice Address - Phone:706-935-6900
Practice Address - Fax:706-935-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GAPHRE0095283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA591599818AMedicaid
GA591599818AMedicaid