Local City Search for Medical Equipment Suppliers 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:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
2332 W 12600 S STE C RIVERTON, UT 84065 US
Tel: 801-253-6778 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 3336M0003X | Suppliers Pharmacy Managed Care Organization Pharmacy | UT | 64211071704 |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 4610754 | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
