NPIMap

Organization Active NPI

Highland Park CVS, L.L.C.

Doing business as CVS Pharmacy # 07170

  • Pharmacy
  • Round Lake, IL
National Provider Identifier
1790882280
Registry record updated Jun 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
5401-5404 Issued in IL
Legal business name
HIGHLAND PARK CVS, L.L.C.
Doing business as
CVS Pharmacy # 07170
Practice address
1229 West Rte 134
Round Lake, IL 60073
Phone
(847) 740-6795
NPI assigned
Sep 19, 2006
Last updated
Jun 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2010

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 5401-5404 IL Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1229 West Rte 134
Round Lake, IL 60073

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146

Other identifiers 1

IdentifierTypeStateIssuer
1477620OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • CVS PHARMACY # 07170 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080103000235 IL Part B Supplier - Mass Immunization (Roster Biller Only) 2860572856 This NPI is an additional NPI on the enrollment
O20100930009975 IL DME Supplier - Pharmacy 2860572856 Practice locations: Round Lake, IL

National Provider Directory

National Provider Directory
Tax ID family
Highland Park CVS LLC309 organizations share this tax ID, including this one

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.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1229 W State Route 134
Round Lake, IL 60073
Phone (847) 740-6795

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1790882280",
    "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": "1229 WEST RTE 134",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "60073",
            "telephone_number": "847-740-6795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND PARK CVS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-19",
        "last_updated": "2010-06-16",
        "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": "5401-5404",
            "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": "1477620",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY # 07170",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Round Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.