Ickes Drug Store

LBN: Ickes Drug Store
Ickes Drug Store is an health care organization with primary practice located at 122 S Juliana St , Bedford PA 15522-1301. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Ickes Drug Store can be contacted via phone (814) 623-5615, or through Ickes, Gary via phone (814) 623-5615.

Contact Information

Primary practice address
122 S Juliana St Bedford PA 15522-1301
Phone: (814) 623-5615
Fax: (814) 623-1465
Website:
Map and Directions
Authorized official contact:
Name: Ickes, Gary
Phone: (814) 623-5615

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X PP411115L Pennsylvania

Profile Details

NPI number 1023178266
LBN Legal business name Ickes Drug Store
DBA Doing business as Ickes Drug Store
Authorized official Ickes, Gary
Entity Organization
Organization subpart 1 No
Enumeration date Dec 11th, 2006
Last updated Dec 21st, 2016 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023178266 NPPES
Pennsylvania MEDICAID 001072318001
Pennsylvania Other 2085756

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