Provider Demographics
NPI:1568423390
Name:ICP INC
Entity Type:Organization
Organization Name:ICP 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 1:175 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-2236
Mailing Address - Country:US
Mailing Address - Phone:724-962-2056
Mailing Address - Fax:724-962-2389
Practice Address - Street 1:175 CANAL ST
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150
Practice Address - Country:US
Practice Address - Phone:888-203-8965
Practice Address - Fax:724-981-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415164L333600000X
PA333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007507000008Medicaid
3971567OtherNCPDP
PA0260170001Medicare ID - Type Unspecified