Provider Demographics
NPI:1861646366
Name:ICU INC
Entity Type:Organization
Organization Name:ICU INC
Other - Org Name:PRIME CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UCHECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWILO
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR OF PHA
Authorized Official - Phone:410-804-8227
Mailing Address - Street 1:5500 SINCLAIR LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4605
Mailing Address - Country:US
Mailing Address - Phone:443-453-9963
Mailing Address - Fax:443-453-9965
Practice Address - Street 1:5500 SINCLAIR LN
Practice Address - Street 2:SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-4605
Practice Address - Country:US
Practice Address - Phone:443-453-9963
Practice Address - Fax:443-453-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP048383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118002OtherPK