Provider Demographics
NPI:1295761401
Name:PROCARE PHARMACEUTICALS LLC
Entity type:Organization
Organization Name:PROCARE PHARMACEUTICALS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BENAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-463-2157
Mailing Address - Street 1:5061 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5061 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2706
Practice Address - Country:US
Practice Address - Phone:773-463-2157
Practice Address - Fax:773-463-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1478545OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IL0=========001Medicaid