Provider Demographics
NPI:1093776825
Name:I C P INC
Entity Type:Organization
Organization Name:I C P INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:419-447-6216
Mailing Address - Street 1:1815 W COUNTY RD 54
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-9667
Mailing Address - Country:US
Mailing Address - Phone:419-447-6216
Mailing Address - Fax:419-447-1878
Practice Address - Street 1:1815 W COUNTY ROAD 54
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-7723
Practice Address - Country:US
Practice Address - Phone:800-228-8278
Practice Address - Fax:419-447-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020434650333600000X
OH333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0595977Medicaid
3644312OtherNCPDP
3644312OtherNCPDP
OH0595977Medicaid