Highland Park CVS, L.L.C.
Organization Active NPI Community/Retail Pharmacy · Swansea, IL
NPI 1295770295 · NPPES record last updated Jul 15, 2020
Key facts
- NPI
- 1295770295
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- HIGHLAND PARK CVS, L.L.C.
- Practice address
- 2665 N Illinois St
Swansea, IL 62226-2302 - Phone
- (618) 236-1177
- Fax
- (618) 236-1178
- NPI assigned
- Jun 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Colbert
- Title
- Sr. Director, Payer Relations
- Phone
- (401) 770-2751
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Highland Park CVS LLC |
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 |
| O20201112001028 | IL | DME Supplier - Pharmacy | 2860572856 | Practice locations: Swansea, IL |
National Provider Directory
- Tax ID family
- Highland Park CVS LLC
Locations
2665 N Illinois St
Swansea, IL 62226
Phone (618) 236-1177
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diabetes Educator Registered Nurse |
163WD0400X | |||
| Medical Specialty Clinic/Center | 261QM2500X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | 054009327 | IL | |
| Pharmacy | 333600000X | 054009327 | IL | |
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
2665 N Illinois St
Swansea, IL 62226-2302
Mailing address
1 CVS Drive
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1455496 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 430726776120 | Medicaid | IL |
Other names
- CVS Pharmacy #18014
Other providers in Swansea, IL
- Abigail Madison Heitzig
- Megan Helldoerfer
- Cammee Cecilia Henry
- Jane Marie Herrmann
- High Mount School District #116
- Tiffany Rose Hislope
- Holistic Counseling PLLC
- Nicholas Alan Holtzman
- Homer a Ferguson, Jr, MD, PC
- Andrew Hood
All providers in Swansea, IL · Community/Retail Pharmacy in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2020. 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.