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

Medicare Provider Information

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
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	54015086	IL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1476440	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

NPI Number	:	1760580591
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	:	PO BOX 1075
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	:	101 ASBURY AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-3801
Country	:	US
Telephone Number	:	847-905-3300
Fax Number	:	847-905-3306

Authorized Official
Title or Position	:	DIRECTOR, PAYER RELATIONS
Name	:	SUSAN COLBERT
Credential	:
Telephone Number	:	401-770-2751

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/17/2023

181 ASBURY AVE
EVANSTON, IL
60202-3801

Practice Phone: 773-340-0068
Practice Fax:

101 ASBURY AVE
EVANSTON, IL
60202-3801