Organization
HIGHLAND PARK CVS, L.L.C.
Active
Other names
CVS Pharmcay # 04061
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIANA MAURICIO (MGR PHCY ENROLLMENTS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
520 S. STATE STREET, CHICAGO, IL 60605
(312) 697-0021
Mailing address
ONE CVS DRIVE, BOX 1075 - PHARMACY ENROLLMENTS, WOONSOCKET, RI 02895
(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
—
1482443
NCPDP
IL
Enumeration date
09/03/2008
Last updated
10/08/2014
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