Organization
PROCARE PHARMACY, L.L.C.
Active
Other names
CVS/PHARMACY #48611
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON AYCOCK (PRESIDENT)
(401) 765-1500
Entity
Organization
Contact information
Practice address
141 PREBLE ST, PORTLAND, ME 04101-2440
(207) 899-0939
(207) 899-0968
Mailing address
PO BOX 99794, CHICAGO, IL 60696-7594
(401) 765-1500
(401) 770-3094
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
PH50001530
ME
3336S0011X
Specialty Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1248900057
MEDICARE NSC
ME
05
—
1417100447
—
ME
01
—
2153870
PK
—
Enumeration date
11/04/2008
Last updated
12/10/2025
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