# HIGHLAND PARK CVS, L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS PHARMACY \#17683
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134578354
- **Authorized official:** SUSAN COLBERT (SR DIRECTOR PAYER RELATIONS)
- **Authorized official phone:** (401) 765-1500

## Contact information

- **Practice address:** 2650 N CLARK ST, CHICAGO, IL 60614-1523
- **Practice address phone:** (773) 525-0179
- **Mailing address:** ONE CVS DRIVE, WOONSOCKET, RI 02895
- **Mailing address phone:** (401) 765-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | IL | — |
| 333600000X | Pharmacy | — | IL | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | IL | — |

## Other

- **Enumeration date:** 06/08/2016
- **Last updated:** 10/26/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1492494 | NCPDP | IL |