Organization
PROCARE PHARMACY, LLC
Active
Other names
CVS/PHARMACY #48637, Encompass Rx 48637
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON AYCOCK (PRESIDENT)
(401) 765-1500
Entity
Organization
Contact information
Practice address
2700 NORTHEAST EXPY NE, SUITE B-800, ATLANTA, GA 30345
(404) 367-9111
(404) 367-9199
Mailing address
1127 BRYN MAWR AVE, REDLANDS, CA 92374-4558
(909) 799-4174
(909) 799-4364
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
PHRE009830
GA
3336S0011X
Specialty Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003123975A
—
GA
05
—
058513900
—
DC
05
—
1417216128
—
VA
01
—
2135141
PK
—
05
—
7G9830
—
SC
Enumeration date
05/15/2012
Last updated
12/10/2025
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