Organization
HIGHLAND PARK CVS LLC
Active
Other names
CVS PHARMACY #10774
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR PAYER RELATIONS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
506 E MAIN ST, STAUNTON, IL 62088-1561
(618) 635-2538
Mailing address
1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
(401) 765-1500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
IL
333600000X
Pharmacy
Primary
—
IL
3336C0003X
Community/Retail Pharmacy
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1490971
NCPDP
IL
05
—
7215386
—
IL
Enumeration date
08/28/2015
Last updated
01/19/2023
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