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NPI Code Detail

MEDICARE: HIGHLANDS COMMUNITY PHARMACY LLC

MEDICARE: HIGHLANDS COMMUNITY PHARMACY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy30625TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12158040OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124487699
Entity Type Code : Organization
Provider Name (Legal Business Name) : HIGHLANDS COMMUNITY PHARMACY LLC
Provider Business Mailing Address
First Line : 607 E WALLISVILLE RD BLDG 1
Second Line :
City : HIGHLANDS
State : TX
Zip : 77562-3831
Country : US
Telephone Number : 832-838-8560
Fax Number : 832-838-8468
Provider Business Practice Location Address
First Line : 607 E WALLISVILLE RD BLDG 1
Second Line :
City : HIGHLANDS
State : TX
Zip : 77562-3831
Country : US
Telephone Number : 832-838-8560
Fax Number : 832-838-8468
Authorized Official
Title or Position : PHARMACIST IN CHARGE
Name : KEVIN EDWARDS
Credential :
Telephone Number : 832-838-8560
Provider Enumeration Date : 02/12/2016
Last Update Date : 04/26/2016

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