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Organization
HIGHLAND PARK CVS, L.L.C.
Active
Organization
HIGHLAND PARK CVS, L.L.C.
Active
Other names
CVS Pharmacy 07017
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1130 S VETERANS PKWY, BLOOMINGTON, IL 61704
(309) 661-1839
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895-6146
(401) 765-1500
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
—
1483611
NCPDP
—
Enumeration date
07/29/2009
Last updated
10/15/2014
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