Organization
HIGHLAND PARK CVS, L.L.C.
Active
Other names
CVS PHARMACY #03901
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1711 SHERMAN AVE, EVANSTON, IL 60201-3712
(847) 328-3105
Mailing address
1 CVS DR, PO 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
—
—
333600000X
Pharmacy
Primary
54015269
IL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477137
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
P00754282
MEDICARE RR
—
Enumeration date
09/12/2006
Last updated
10/08/2014
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