Organization
PROCARE LTC OF MA LLC
Active
Other names
PROCARE LTC OF MA, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BINCY VARGHESE PHARM D (DIRECTOR OF COMPLIANCE)
(888) 741-0367
Entity
Organization
Contact information
Practice address
155 NORTHBORO RD STE 4, SOUTHBOROUGH, MA 01772-1033
(508) 481-5800
(508) 481-5801
Mailing address
1 OLYMPIC PL STE 600, TOWSON, MD 21204-4110
(888) 741-0367
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
DS90042
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110115534A
—
MA
01
—
2160164
PK
—
Enumeration date
05/16/2016
Last updated
06/07/2024
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