Organization
PROCARE 4268 YANKEE, L.L.C.
Active
Other names
Damer & Cartwright Pharmacy # 04268
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTIANA MAURICIO (MANAGER, PHARMACY ENROLLMENTS)
(401) 765-1500
Entity
Organization
Contact information
Practice address
104 S MICHIGAN AVE, SUITE 619, CHICAGO, IL 60603-5902
(312) 252-7204
(312) 332-6140
Mailing address
104 S MICHIGAN AVE, SUITE 619, CHICAGO, IL 60603-5902
(312) 252-7204
(312) 332-6140
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054015141
IL
333600000X
Pharmacy
Primary
054015141
IL
3336C0003X
Community/Retail Pharmacy
054015141
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054015141
RESIDENT STATE LICENSE #
IL
01
—
1476820
COMMERCIAL NUMBER
IL
05
—
200326858001
—
IL
01
—
320008059
RESIDENT STATE C/S LIC #
IL
Enumeration date
06/11/2006
Last updated
03/07/2023
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