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General NPI Number Information
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NPI Number | 1174807002
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Entity Type | Organization
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Legal Business Name | PROCARE LTC PHARMACY OF CONNECTICUT LLC
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 1492 HIGHLAND AVE STE 1C
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City | CHESHIRE
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State | CT
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Zip | 06410-1287
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Country | US
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Telephone | 203-439-9099
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Fax | 631-963-3990
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Provider Business Mailing Address
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Address Line | 1 OLYMPIC PL STE 600
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City | TOWSON
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State | MD
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Zip | 21204-4110
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Country | US
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Telephone | 877-741-0367
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | DR. BINCY VARGHESE
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Credential | PHARM D
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Telephone | 888-741-0367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHN11041
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 031744
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PCY0002214
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License Number State | CT
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