=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447258140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGHLAND CLINIC PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1455 E BERT KOUNS INDUSTRIAL LOOP
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71105-5634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-798-4612
-----------------------------------------------------
Fax | 318-798-4615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51455
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71135-1455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-798-4612
-----------------------------------------------------
Fax | 318-798-4615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/CEO
-----------------------------------------------------
Name | DEBBIE W. SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-798-4539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | C004738-IR
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------