Organization
HIGHLAND PARK CVS, L.L.C.
Active
Other names
CVS Pharmacy# 07020
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, MANAGED CARE CONTRACT ADM)
(401) 765-1500
Entity
Organization
Contact information
Practice address
1701 FORT JESSE RD, NORMAL, IL 61761-2285
(309) 452-1370
Mailing address
1 CVS DR, BOX 1075 - PHARMACY ENROLLMENTS, 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
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1483623
NCPDP
—
Enumeration date
08/03/2009
Last updated
10/15/2014
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