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ICOTADAI INC

Managed Care Organization Pharmacy

Riverton, Utah

Provider NPI: 1366586430

Organization Information:
Organization Name:  ICOTADAI INC


Practice Location:
2332 W 12600 S STE C RIVERTON, UT 84065 US
Tel: 801-253-6778  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y3336M0003XSuppliers
Pharmacy
Managed Care Organization Pharmacy
UT64211071704

Other Provider Identifiers:

IssuerNumberStateType
OTHER ID NUMBER-COMMERCIAL NUMBER461075401
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MANAGED CARE JOBS UT - Page 1



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