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General NPI Number Information
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NPI Number | 1417100447
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Entity Type | Organization
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Legal Business Name | PROCARE PHARMACY, L.L.C.
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 141 PREBLE ST
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City | PORTLAND
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State | ME
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Zip | 04101-2440
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Country | US
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Telephone | 207-899-0939
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Fax | 207-899-0968
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Provider Business Mailing Address
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Address Line | PO BOX 99794
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City | CHICAGO
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State | IL
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Zip | 60696-7594
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Country | US
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Telephone | 401-765-1500
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Fax | 401-770-3094
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRANDON AYCOCK
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Credential |
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Telephone | 401-765-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH50001530
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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