Healthcare Provider Details

I. General information

NPI: 1508938879
Provider Name (Legal Business Name): PROCARE PHARMACY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 HARDEN STREET EXT SUITE 300
COLUMBIA SC
29203-6800
US

IV. Provider business mailing address

1 CVS DR BOX 1075 - PHARMACY ENROLLMENTS
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 803-551-1030
  • Fax:
Mailing address:
  • Phone: 401-765-1500
  • Fax: 401-770-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 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 Number50007422
License Number StateSC

VIII. Authorized Official

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