Provider Demographics
NPI:1962773135
Name:PROCARE PHARMACY LLC
Entity type:Organization
Organization Name:PROCARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THAI
Authorized Official - Middle Name:
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-426-6414
Mailing Address - Street 1:6870 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2106
Mailing Address - Country:US
Mailing Address - Phone:702-207-7777
Mailing Address - Fax:702-207-0644
Practice Address - Street 1:6870 S RAINBOW BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2106
Practice Address - Country:US
Practice Address - Phone:702-207-7777
Practice Address - Fax:702-207-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH027743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2992887OtherNCPDP PROVIDER IDENTIFICATION NUMBER