Organization
HIGHLAND PARK CVS LLC
Active
Other names
CVS Pharmacy #17536
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
130 S MANNHEIM RD, HILLSIDE, IL 60162-1821
(708) 375-5072
(708) 375-5082
Mailing address
1 CVS DR, BOX 1075, 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
054.019750
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2118412
PK
—
Enumeration date
01/07/2009
Last updated
09/23/2016
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