Healthcare Provider Details

I. General information

NPI: 1932556438
Provider Name (Legal Business Name): PROCARE LTC OF MA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 NORTHBORO RD STE 4
SOUTHBOROUGH MA
01772-1033
US

IV. Provider business mailing address

1 OLYMPIC PL STE 600
TOWSON MD
21204-4110
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-5800
  • Fax: 508-481-5801
Mailing address:
  • Phone: 888-741-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberDS90042
License Number StateMA

VIII. Authorized Official

Name: DR. BINCY VARGHESE
Title or Position: DIRECTOR OF COMPLIANCE
Credential: PHARM D
Phone: 888-741-0367