Healthcare Provider Details

I. General information

NPI: 1225504186
Provider Name (Legal Business Name): PROCARE LTC OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E WILSON BRIDGE RD SUITE B
WORTHINGTON OH
43085
US

IV. Provider business mailing address

1 OLYMPIC PL STE 600
TOWSON MD
21204-4110
US

V. Phone/Fax

Practice location:
  • Phone: 614-964-4610
  • Fax:
Mailing address:
  • Phone: 888-741-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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