Provider Demographics
NPI:1356577092
Name:ICARD, PHIL FRANKLIN (RPH)
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:FRANKLIN
Last Name:ICARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 NC HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3048
Mailing Address - Country:US
Mailing Address - Phone:282-632-2271
Mailing Address - Fax:828-632-2220
Practice Address - Street 1:255 NC HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-3048
Practice Address - Country:US
Practice Address - Phone:282-632-2271
Practice Address - Fax:828-632-2220
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist