Healthcare Provider Details

I. General information

NPI: 1467314468
Provider Name (Legal Business Name): PROCARE SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2025
Last Update Date: 11/27/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 FOREST AVE
STATEN ISLAND NY
10303-1752
US

IV. Provider business mailing address

2220 FOREST AVE
STATEN ISLAND NY
10303-1752
US

V. Phone/Fax

Practice location:
  • Phone: 718-973-9722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER M
Title or Position: PHARMACIST
Credential:
Phone: 718-973-9722