Organization
HIGHLAND PARK CVS LLC
Active
Other names
CVS PHARMACY # 04189
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN COLBERT (DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization
Contact information
Practice address
2828 N CLARK ST, CHICAGO, IL 60657-5775
(773) 525-1377
Mailing address
ONE CVS DRIVE, 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
—
1487138
NCPDP
IL
Enumeration date
08/06/2012
Last updated
06/19/2013
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