NPIMap

Organization Active NPI

Procare LTC Pharmacy of Connecticut LLC

  • Long Term Care Pharmacy
  • Cheshire, CT
National Provider Identifier
1174807002
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PCY0002214 Issued in CT
Legal business name
PROCARE LTC PHARMACY OF CONNECTICUT LLC
Practice address
1492 Highland Ave Ste 1C
Cheshire, CT 06410-1287
Phone
(203) 439-9099
Fax
(631) 963-3990
NPI assigned
Oct 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bincy Varghese, PHARM D
Title
Director of Compliance
Phone
(888) 741-0367

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 031744 NY
Long Term Care Pharmacy 3336L0003X PCY0002214 CT Primary
Long Term Care Pharmacy 3336L0003X PHN11041 RI

Addresses

Primary practice location

1492 Highland Ave Ste 1C
Cheshire, CT 06410-1287

Mailing address

1 Olympic PL Ste 600
Towson, MD 21204-4110
Phone (877) 741-0367

Other identifiers 2

IdentifierTypeStateIssuer
02869827MedicaidCT
2132865OtherPK

Other names 1

  • Procare LTC Pharmacy of Connecticut LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140124000454 CT DME Supplier - Pharmacy 3577791300 Practice locations: Cheshire, CT
O20210324003038 CT Part B Supplier - Mass Immunization (Roster Biller Only) 3577791300 Practice locations: Cheshire, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Procare LTC Pharmacy of CT LLC1492 Highland Ave, Cheshire, CT 06410-1287(203) 439-9099 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Does not accept assignmentParticipating since Jan 24, 2014

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1492 Highland Ave
Ste 1C
Cheshire, CT 06410
Phone (203) 439-9099

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1174807002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 OLYMPIC PL STE 600",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212044110",
            "telephone_number": "877-741-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1492 HIGHLAND AVE STE 1C",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064101287",
            "telephone_number": "203-439-9099",
            "fax_number": "631-963-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE LTC PHARMACY OF CONNECTICUT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-11",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "VARGHESE",
        "authorized_official_first_name": "BINCY",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "888-741-0367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "031744",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CT",
            "license": "PCY0002214",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "RI",
            "license": "PHN11041",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02869827",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132865",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Procare LTC Pharmacy of Connecticut LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Procare LTC Pharmacy of Connecticut LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheshire, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.