Healthcare Provider Details

I. General information

NPI: 1407626948
Provider Name (Legal Business Name): HIGHLAND PARK CVS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4728 W IRVING PARK RD
CHICAGO IL
60641-2701
US

IV. Provider business mailing address

1 CVS DR BOX 1075
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 773-628-0043
  • Fax:
Mailing address:
  • Phone: 401-765-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN F COLBERT
Title or Position: SR. DIRECTOR
Credential:
Phone: 800-746-7287