Organization
HIGHLAND PARK CVS, L.L.C.
Active
Parent organization
SCHNUCK MARKETS INC
Other names
CVS Pharmacy #18091, SCHNUCKS PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
SCHNUCK MARKETS INC
Authorized official
SUSAN F COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
1129 W BROADWAY, CENTRALIA, IL 62801-5353
(618) 532-4993
(618) 532-1617
Mailing address
1 CVS DR # 1075, WOONSOCKET, RI 02895-6146
(701) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
333600000X
Pharmacy
05412056
IL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1465889
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
430726776733
—
IL
Enumeration date
06/25/2006
Last updated
07/14/2020
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