# HIGHLAND PARK CVS, L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy \#18084, SCHNUCKS PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497790406
- **Authorized official:** SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 4800 N UNIVERSITY ST, PEORIA, IL 61614-5891
- **Practice address phone:** (309) 690-3250
- **Practice address fax:** (309) 690-3251
- **Mailing address:** 1 CVS DRIVE, BOX 1075, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WD0400X | Diabetes Educator Registered Nurse | — | NULL | — |
| 163WD0400X | Diabetes Educator Registered Nurse | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 054014198 | IL | — |
| 333600000X | Pharmacy | 054014198 | IL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/17/2006
- **Last updated:** 06/26/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1470967 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |
| 05 | — | 430726776721 | — | IL |