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Organization

PROCARE PHARMACY LLC

Active
Other names
CVS Pharmacy #00102
Organization subpart
No

Provider details

NPI number
Authorized official
SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS)
(401) 770-2751
Entity
Organization

Contact information

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

Taxonomy

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

Other

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
Enumeration date
09/12/2006
Last updated
12/20/2022
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