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Contact Information

HIGHLAND PARK CVS, L.L.C.
1034 W. REYNOLDS STREET
PONTIAC, IL61764
 Phone: 815-842-6774
 Fax: 815-842-2648
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for HIGHLAND PARK CVS, L.L.C.

NPI # 1326123340
LBN Legal business name HIGHLAND PARK CVS, L.L.C.
Authorized official SUSAN COLBERT - (SR. DR. PAYER RELATIONS)
Entity Organization
Organization subpart 1 No
Enumeration date 10/26/2006
Last updated 07/21/2022 - About 4 years ago
Identifiers
IL License # 054-008366
IL License # 203000699
IL Medicaid 363484164017
Other 14-48794 NABP
IL Other 054-008366 PHARMACY LIC
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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