Organization
HIGHLAND PARK CVS, L.L.C.
Active
Other names
CVS Pharmacy #10680
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (SR. DR. PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
47 S. LOCUST STREET, MANTENO, IL 60950
(815) 468-0190
(815) 468-0165
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
203000673
IL
3336C0003X
Community/Retail Pharmacy
Primary
054-013255
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-013255
PHARMACY LIC
IL
01
—
14-67124
NABP
—
05
—
363484164007
—
IL
Enumeration date
10/26/2006
Last updated
07/21/2022
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