Provider Demographics
NPI:1326684069
Name:PROCARE LTC OF SYRACUSE, LLC
Entity type:Organization
Organization Name:PROCARE LTC OF SYRACUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:DR
Authorized Official - First Name:BINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:631-359-9711
Mailing Address - Street 1:1 OLYMPIC PL STE 600
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4110
Mailing Address - Country:US
Mailing Address - Phone:888-741-0367
Mailing Address - Fax:
Practice Address - Street 1:105 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-1205
Practice Address - Country:US
Practice Address - Phone:315-800-6400
Practice Address - Fax:315-800-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy