Healthcare Provider Details

I. General information

NPI: 1447258140
Provider Name (Legal Business Name): HIGHLAND CLINIC PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71105-5634
US

IV. Provider business mailing address

PO BOX 51455
SHREVEPORT LA
71135-1455
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-4612
  • Fax: 318-798-4615
Mailing address:
  • Phone: 318-798-4612
  • Fax: 318-798-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberC004738-IR
License Number StateLA

VIII. Authorized Official

Name: DEBBIE W. SMITH
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 318-798-4539