Highland Park CVS, L.L.C.
Organization Active NPI Pharmacy · Hickory Hills, IL
NPI 1104999002 · NPPES record last updated Oct 8, 2014
Key facts
- NPI
- 1104999002
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 54016069 (IL)
- Legal business name
- HIGHLAND PARK CVS, L.L.C.
- Practice address
- 8811 W 87TH Street
Hickory Hills, IL 60457 - Phone
- (708) 430-6780
- NPI assigned
- Nov 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Cristiana Mauricio
- Title
- Manager Pharmacy Enrollments
- Phone
- (401) 770-2937
Corporate family (same tax ID) 24
Member of 1
Practitioners 5
-
Ernest Chen, PHARMD
-
Jocelyn D Gorokhovsky, LCSW, RPH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2283710 | CVS/Pharmacy #00834 | Certificate of waiver | Jun 11, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #00834 |
Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080103000235 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2860572856 | This NPI is an additional NPI on the enrollment |
| O20100930092081 | IL | DME Supplier - Pharmacy | 2860572856 | Practice locations: Hickory Hills, IL |
National Provider Directory
- Tax ID family
- Highland Park CVS LLC
Locations
8811 W 87th St
Hickory Hills, IL 60457
Phone (708) 430-6780
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 54016069 | IL | Yes |
Addresses
Primary practice location
8811 W 87TH Street
Hickory Hills, IL 60457
Mailing address
1 CVS Dr
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names
- CVS Pharmacy # 00834
Other providers in Hickory Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.