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Organization

HIGHLAND PARK CVS, L.L.C.

Active
Other names
SCHNUCKS PHARMACY, CVS Pharmacy #18078
Organization subpart
No

Provider details

NPI number
Authorized official
SUSAN F COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization

Contact information

Practice address
109 N MATTIS AVE, CHAMPAIGN, IL 61821-3059
(217) 351-8497
(217) 351-8056
Mailing address
1 CVS DR # 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500

Taxonomy

Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
261QM2500X
Medical Specialty Clinic/Center
332B00000X
Durable Medical Equipment & Medical Supplies
054001003
IL
333600000X
Pharmacy
054001003
IL
3336C0003X
Community/Retail Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1459634
OTHER ID NUMBER-COMMERCIAL NUMBER
05
430726776707
IL
Enumeration date
06/25/2006
Last updated
07/14/2020
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