Provider Demographics
NPI:1922579127
Name:ICARERX PHARMACY LLC
Entity Type:Organization
Organization Name:ICARERX PHARMACY LLC
Other - Org Name:SAGINAW CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRAVANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:VENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-200-1080
Mailing Address - Street 1:117 MAIN ST, STE A
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:TX
Mailing Address - Zip Code:76250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 WJ BOAZ RD STE 100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1290
Practice Address - Country:US
Practice Address - Phone:682-200-1080
Practice Address - Fax:682-708-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32381OtherTEXAS BOARD OF PHARMACY