# HIGHLAND PARK CVS, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS PHARMACY \#10628
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306394051
- **Authorized official:** SUSAN COLBERT (SR DIRECTOR PAYER RELATIONS)
- **Authorized official phone:** (401) 765-1500

## Contact information

- **Practice address:** 177 W VIRGINIA STREET, CRYSTAL LAKE, IL 60014
- **Practice address phone:** (815) 444-4603
- **Mailing address:** ONE CVS DRIVE, BOX 1075, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500
- **Mailing address fax:** (401) 770-7108

## 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:** 09/12/2016
- **Last updated:** 11/02/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1492761 | NCPDP | IL |