NPIMap

Organization Active NPI

Procare Pharmacy, L.L.C.

  • Specialty Pharmacy
  • Portland, ME
National Provider Identifier
1417100447
Registry record updated Dec 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
Legal business name
PROCARE PHARMACY, L.L.C.
Practice address
141 Preble St
Portland, ME 04101-2440
Phone
(207) 899-0939
Fax
(207) 899-0968
NPI assigned
Nov 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2025

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

Authorized official

Name
Brandon Aycock
Title
President
Phone
(401) 765-1500

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PH50001530 ME
Specialty Pharmacy 3336S0011X Primary

Addresses

Primary practice location

141 Preble St
Portland, ME 04101-2440

Mailing address

PO Box 99794
Chicago, IL 60696-7594
Phone (401) 765-1500

Other identifiers 3

IdentifierTypeStateIssuer
2153870OtherPK
1248900057OtherMEMEDICARE NSC
1417100447MedicaidME

Other names 1

  • CVS/PHARMACY #48611 Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180413000279 ME DME Supplier - Pharmacy 5496643652 Practice locations: Portland, ME

Other NPIs with the same Medicare PAC ID 21

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 21

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 Pharmacy LLC141 Preble St, Portland, ME 04101-2440(877) 814-8447 Immunosuppressive Drugs|Infusion Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Ente… Accepts assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
CVS Pharmacy 0270814 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Member of 1

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

Locations

141 Preble St
Portland, ME 04101
Phone (207) 899-0939

84 Marginal Way
Ste 100
Portland, ME 04101

64 E St
South Portland, ME 04106

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765324800000",
    "number": "1417100447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99794",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606967594",
            "telephone_number": "401-765-1500",
            "fax_number": "401-770-3094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 PREBLE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012440",
            "telephone_number": "207-899-0939",
            "fax_number": "207-899-0968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE PHARMACY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-04",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A",
        "authorized_official_last_name": "AYCOCK",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-765-1500"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ME",
            "license": "PH50001530",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153870",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NSC",
            "identifier": "1248900057",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417100447",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CVS/PHARMACY #48611",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; 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.