MEDICARE: HIGHLAND PARK DRUG STORE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	26326	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2119221	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649410770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND PARK DRUG STORE INC

Provider Business Mailing Address
First Line	:	3801 N CAPITAL OF TEXAS HWY # G205
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-1416
Country	:	US
Telephone Number	:	512-617-0993
Fax Number	:	512-617-0995

Provider Business Practice Location Address
First Line	:	3801 N CAPITAL OF TEXAS HWY # G205
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-1416
Country	:	US
Telephone Number	:	512-617-0993
Fax Number	:	512-617-0995

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TOM SANSING
Credential	:
Telephone Number	:	512-617-0993

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	09/19/2025

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