Organization
HIGHLAND PARK CVS, L.L.C.
Active
Parent organization
SCHNUCK MARKETS INC
Other names
CVS Pharmacy #18030
Organization subpart
Yes
Provider details
NPI number
Legal business name
SCHNUCK MARKETS INC
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
625 LINCOLN HIGHWAY, FAIRVIEW HEIGHTS, IL 62208-2121
(618) 624-4313
(618) 624-4315
Mailing address
1 CVS DRIVE, BOX 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
054008431
IL
333600000X
Pharmacy
054008431
IL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1449289
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
430957246144
—
IL
Enumeration date
06/25/2006
Last updated
07/15/2020
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