Organization
HIGHLAND PARK CVS, L.L.C
Active
Other names
CVS Pharmacy #10624
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DR. PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
902 E OAK ST, FAIRBURY, IL 61739
(815) 692-2132
(815) 692-2393
Mailing address
1 CVS DR, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
20300849
IL
3336C0003X
Community/Retail Pharmacy
Primary
054-016042
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-016042
STATE PHARMACY LIC
IL
01
—
14-79888
NABP
—
05
—
363484164024
—
IL
Enumeration date
11/09/2006
Last updated
07/21/2022
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