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General NPI Number Information
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NPI Number | 1467314468
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Entity Type | Organization
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Legal Business Name | PROCARE SPECIALTY PHARMACY, LLC
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Dates
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Enumeration Date | 11/27/2025
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 2220 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-1752
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Country | US
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Telephone | 718-973-9722
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-1752
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | PETER M
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Credential |
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Telephone | 718-973-9722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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