Provider Demographics
NPI:1942084520
Name:ICARE PHARMACY
Entity Type:Organization
Organization Name:ICARE PHARMACY
Other - Org Name:ICARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-636-4091
Mailing Address - Street 1:2636 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-5823
Mailing Address - Country:US
Mailing Address - Phone:405-636-4091
Mailing Address - Fax:405-353-7023
Practice Address - Street 1:5201 S WESTERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4521
Practice Address - Country:US
Practice Address - Phone:405-768-2270
Practice Address - Fax:405-353-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy