Active NPI
Highland Park CVS, L.L.C.
Doing business as CVS Pharmacy 06448
- Pharmacy
- Washington, IL
National Provider Identifier
1366545139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 054-011848
- Legal business name
- HIGHLAND PARK CVS, L.L.C.
- Doing business as
- CVS Pharmacy 06448
- Practice address
- 1101 Peoria St
Washington, IL 61571-2350 - Phone
- (309) 444-2301
- NPI assigned
- Sep 7, 2006
- Last updated
- Mar 13, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Colbert
- Title
- Director
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 054-011848 | IL | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1101 Peoria St
Washington, IL 61571-2350
Mailing address
1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1442653 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- CVS PHARMACY 06448
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 2
| 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 |
| O20100930083005 | IL | DME Supplier - Pharmacy | 2860572856 | Practice locations: Washington, IL |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2283943 | CVS/Pharmacy #06448 | Certificate of waiver | Jun 13, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #06448 | 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 |
National Provider Directory
National Provider Directory- Tax ID family
- Highland Park CVS LLC
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
1101 Peoria St
Washington, IL 61571
Phone (309) 444-1681
1101 Peoria St
#6448
Washington, IL 61571
Phone (309) 444-2301
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Washington, IL
- NPI 1508469057
-
- Pharmacist
- Washington, IL
- NPI 1336736669
-
- Pharmacist
- Washington, IL
- NPI 1770617714
-
- Pharmacist
- Washington, IL
- NPI 1720952989
-
- Pharmacist
- Washington, IL
- NPI 1427652379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1331596800000",
"number": "1366545139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"address_2": "PO BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 PEORIA ST",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615712350",
"telephone_number": "309-444-2301"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HIGHLAND PARK CVS, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-07",
"last_updated": "2012-03-13",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "IL",
"license": "054-011848",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "1442653",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS PHARMACY 06448",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Washington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.