1992004766 NPI number — HIGHLAND PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992004766 NPI number — HIGHLAND PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLAND PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992004766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1177 N. HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-844-1100
Provider Business Mailing Address Fax Number:
630-844-1101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1177 N. HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-844-1100
Provider Business Practice Location Address Fax Number:
630-844-1101
Provider Enumeration Date:
03/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BAQI
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
ABDUL
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
630-844-1100

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  05417611 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05417611 . This is a "PHARMACY NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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