Healthcare Provider Details

I. General information

NPI: 1174399364
Provider Name (Legal Business Name): HIGHLAND DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST STE A
SANTA FE NM
87505-4781
US

IV. Provider business mailing address

1691 GALISTEO ST STE A
SANTA FE NM
87505-4781
US

V. Phone/Fax

Practice location:
  • Phone: 505-772-9340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SHAW
Title or Position: OWNER
Credential: PHARMD
Phone: 973-647-9172