Organization
HIGHLAND PARK CVS, L.L.C.
Active
Other names
CVS Pharmacy #10599
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
245 S BROADWAY STREET, COAL CITY, IL 60416
(815) 634-0455
(815) 634-4328
Mailing address
1 CVS DRIVE, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
(815) 458-6158
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
203000679
IL
3336C0003X
Community/Retail Pharmacy
Primary
054-008392
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-008392
PHARMACY LIC
IL
05
—
363484164014
—
IL
Enumeration date
10/26/2006
Last updated
01/18/2018
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