Organization
HIGHLAND PARK CVS LLC
Active
Other names
CVS Pharmacy #10627
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DR. PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
720 S CRESCENT, GILMAN, IL 60938
(815) 265-4730
(815) 265-4740
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
203000676
IL
3336C0003X
Community/Retail Pharmacy
Primary
054-013779
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-013779
PHARMACY LIC
IL
01
—
14-68215
NABP
—
05
—
363484164009
—
IL
Enumeration date
10/26/2006
Last updated
07/21/2022
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