Organization
HIGHLAND PARK CVS, L.L.C.
Active
Other names
CVS PHARMACY #10628
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR DIRECTOR PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
177 W VIRGINIA STREET, CRYSTAL LAKE, IL 60014
(815) 444-4603
Mailing address
ONE CVS DRIVE, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
(401) 770-7108
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
IL
333600000X
Pharmacy
Primary
—
IL
3336C0003X
Community/Retail Pharmacy
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1492761
NCPDP
IL
Enumeration date
09/12/2016
Last updated
11/02/2016
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