Healthcare Provider Details

I. General information

NPI: 1710308408
Provider Name (Legal Business Name): HIGHLAND PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ROGERS RD
GLASGOW KY
42141-4110
US

IV. Provider business mailing address

PO BOX 1778
GLASGOW KY
42142-1778
US

V. Phone/Fax

Practice location:
  • Phone: 270-629-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP07492
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberP07492
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberP07492
License Number StateKY

VIII. Authorized Official

Name: DR. TRAVIS HUDNALL
Title or Position: OWNER
Credential: R.PH
Phone: 270-651-5159