# PROCARE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CVS Pharmacy \#00102
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205930104
- **Authorized official:** SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 2101 N URSULA ST UNIT 35, AURORA, CO 80045-7426
- **Practice address phone:** (866) 813-4547
- **Mailing address:** 1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 333600000X | Pharmacy | PDO617 | CO | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |
| 3336S0011X | Specialty Pharmacy | — | — | — |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 12/20/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0619479 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |
| 05 | — | 09981756 (RX) | — | CO |
| 05 | — | 10025711800 | — | NE |
| 01 | — | 1205930104 | MT MEDICAID (RX) | MT |
| 05 | — | 1205930104 | — | UT |
| 01 | — | 135307100 | WY MEDICAID (RX) | WY |
| 05 | — | 200125790B | — | OK |
| 05 | — | 32920768 (DME) | — | CO |
| 01 | — | 33383341 | NM MEDICAID (RX) | NM |