MEDICARE: PROCARE SPECIALTY PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1528920519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE SPECIALTY PHARMACY, LLC

Provider Business Mailing Address
First Line	:	2220 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1752
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-1752
Country	:	US
Telephone Number	:	718-973-9722
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	PETER M
Credential	:
Telephone Number	:	718-973-9722

Provider Enumeration Date	:	11/27/2025
Last Update Date	:	11/27/2025

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Directions to “PROCARE SPECIALTY PHARMACY, LLC ” Practice Location

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