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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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11479460OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1861435240
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 : 2427 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4631
Country : US
Telephone Number : 773-342-6060
Fax Number :
Authorized Official
Title or Position : EXEC DIR, RX SVCS
Name : SUSAN F COLBERT
Credential :
Telephone Number : 401-770-2751
Provider Enumeration Date : 06/14/2006
Last Update Date : 01/19/2023

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