Healthcare Provider Details

I. General information

NPI: 1417100447
Provider Name (Legal Business Name): PROCARE PHARMACY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PREBLE ST
PORTLAND ME
04101-2440
US

IV. Provider business mailing address

PO BOX 99794
CHICAGO IL
60696-7594
US

V. Phone/Fax

Practice location:
  • Phone: 207-899-0939
  • Fax: 207-899-0968
Mailing address:
  • Phone: 401-765-1500
  • Fax: 401-770-3094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH50001530
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDON AYCOCK
Title or Position: PRESIDENT
Credential:
Phone: 401-765-1500