Healthcare Provider Details

I. General information

NPI: 1306618509
Provider Name (Legal Business Name): HIGHLAND PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
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
48328-2163
US

IV. Provider business mailing address

4000 HIGHLAND RD STE 113
WATERFORD MI
48328-2163
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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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