Provider Demographics
NPI:1952481459
Name:HIGHLAND PARK DRUG STORE
Entity Type:Organization
Organization Name:HIGHLAND PARK DRUG STORE
Other - Org Name:NORTHWEST HILLS PHARMACY & FLORIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANSING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:512-345-3712
Mailing Address - Street 1:3910 FAR WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2901
Mailing Address - Country:US
Mailing Address - Phone:512-345-3712
Mailing Address - Fax:
Practice Address - Street 1:3910 FAR WEST BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2901
Practice Address - Country:US
Practice Address - Phone:512-345-3712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAN8242470OtherDEA NUMBER