Healthcare Provider Details

I. General information

NPI: 1558506451
Provider Name (Legal Business Name): HIGHLAND PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HIGHLAND RD STE 113
WATERFORD MI
48328-2167
US

IV. Provider business mailing address

4000 HIGHLAND RD STE 113
WATERFORD MI
48328-2167
US

V. Phone/Fax

Practice location:
  • Phone: 248-977-1394
  • Fax: 248-977-1395
Mailing address:
  • Phone: 248-977-1394
  • Fax: 248-977-1395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number5301009009
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number5301009009
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5301009009
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009009
License Number StateMI

VIII. Authorized Official

Name: NEIL MEHTA
Title or Position: OWNER
Credential:
Phone: 248-977-1394