Provider Demographics
NPI:1366960346
Name:I CARE PHARMACY LLC
Entity type:Organization
Organization Name:I CARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER,AO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-303-3672
Mailing Address - Street 1:34064 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2644
Mailing Address - Country:US
Mailing Address - Phone:727-303-3672
Mailing Address - Fax:727-255-5699
Practice Address - Street 1:34064 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2644
Practice Address - Country:US
Practice Address - Phone:727-303-3672
Practice Address - Fax:727-255-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH309403336C0003X, 3336S0011X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2174375OtherPK