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Organization
HIGHLAND PARK CVS LLC
Active
Organization
HIGHLAND PARK CVS LLC
Active
Other names
CVS PHARMACY# 01493
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIANA MAURICIO (MGR PHCY ENROLLMENTS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
5205 N BROADWAY ST, CHICAGO, IL 60640-2303
(773) 275-5641
Mailing address
1 CVS DR, BOX 1075- PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1482152
NCPDP
—
Enumeration date
07/08/2008
Last updated
10/08/2014
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