Healthcare Provider Details

I. General information

NPI: 1295582476
Provider Name (Legal Business Name): HIGHLAND DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2024
Last Update Date: 05/04/2024
Certification Date: 05/04/2024
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: 888-357-2570
Mailing address:
  • Phone: 505-772-9340
  • Fax: 888-357-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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