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NPI Code Detail

MEDICARE: HIGHLAND PARK CVS LLC

MEDICARE: HIGHLAND PARK CVS LLC
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
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacy

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00754411OTHERILMEDICARE RR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21479511OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1407897374
Entity Type Code : Organization
Provider Name (Legal Business Name) : HIGHLAND PARK CVS LLC
Provider Business Mailing Address
First Line : 1 CVS DR
Second Line : PO BOX 1075
City : WOONSOCKET
State : RI
Zip : 02895-6146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6748 W 111TH ST
Second Line :
City : WORTH
State : IL
Zip : 60482-1912
Country : US
Telephone Number : 708-361-9701
Fax Number :
Authorized Official
Title or Position : EXEC DIR, RX SVCS
Name : SUSAN F COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 06/09/2006
Last Update Date : 01/19/2023

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Directions to “HIGHLAND PARK CVS LLC ” Practice Location

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