# HIGHLAND PARK CVS, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Schnucks Pharmacy 205, CVS Pharmacy \#18048
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790260552
- **Authorized official:** SUSAN F COLBERT (SR. DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 800 CARLYLE AVE, BELLEVILLE, IL 62221-5509
- **Practice address phone:** (618) 277-0419
- **Practice address fax:** (618) 277-0494
- **Mailing address:** 1 CVS DR \# 1075, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500
- **Mailing address fax:** (314) 994-4586

## 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 | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/27/2018
- **Last updated:** 07/14/2020