Provider Demographics
NPI:1720401722
Name:ICARE PHARMACY
Entity Type:Organization
Organization Name:ICARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY IN CHARGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:973-429-0444
Mailing Address - Street 1:194 BROAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2606
Mailing Address - Country:US
Mailing Address - Phone:973-429-0444
Mailing Address - Fax:973-429-0440
Practice Address - Street 1:194 BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2606
Practice Address - Country:US
Practice Address - Phone:973-429-0444
Practice Address - Fax:973-429-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007315003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00731500OtherPHARMACY PERMIT NUMBER
NJ7084960001Medicare NSC