Provider Demographics
NPI:1518200567
Name:ICARE PHARMACY PLUS LLC
Entity Type:Organization
Organization Name:ICARE PHARMACY PLUS LLC
Other - Org Name:PHARMACY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:862-257-9990
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2619
Mailing Address - Country:US
Mailing Address - Phone:862-257-9990
Mailing Address - Fax:862-267-9991
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2619
Practice Address - Country:US
Practice Address - Phone:862-257-9990
Practice Address - Fax:862-267-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
NJ28RS007252003336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139624OtherPK
NJ0382434Medicaid
6793740001Medicare NSC