Healthcare Provider Details

I. General information

NPI: 1073737003
Provider Name (Legal Business Name): PROCARE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 PIKE ST
SHINNSTON WV
26431-1435
US

IV. Provider business mailing address

720 PIKE ST
SHINNSTON WV
26431-1435
US

V. Phone/Fax

Practice location:
  • Phone: 304-592-2680
  • Fax: 304-592-2684
Mailing address:
  • Phone: 304-592-2680
  • Fax: 304-592-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0552301
License Number StateWV

VIII. Authorized Official

Name: MRS. YVONNE KAY WEST
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 304-592-2680