MEDICARE: HIGHLAND PARK CVS, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	203000672	IL
2	3336C0003X	Community/Retail Pharmacy	54-014073	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	54-014073	OTHER	IL	PHARMACY LIC
3	14-70070	OTHER		NABP

General Provider Information

NPI Number	:	1063598068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND PARK CVS, L.L.C.

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	401-765-1500
Fax Number	:	401-770-7108

Provider Business Practice Location Address
First Line	:	2764 N. ROUTE 1-17
Second Line	:
City	:	MOMENCE
State	:	IL
Zip	:	60954
Country	:	US
Telephone Number	:	815-472-3223
Fax Number	:	815-472-3253

Authorized Official
Title or Position	:	SR. DR. PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/21/2022

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Directions to “HIGHLAND PARK CVS, L.L.C. ” Practice Location

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