MEDICARE: ALI LOIS ICENOGLE PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH61056519	WA

General Provider Information

NPI Number	:	1053824003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI LOIS ICENOGLE PHARMACIST

Provider Business Mailing Address
First Line	:	2501 W ORANGE GROVE RD UNIT 66
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3417
Country	:	US
Telephone Number	:	480-789-9151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 S 6TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85723-1532
Country	:	US
Telephone Number	:	520-792-1450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	09/29/2021

Similar Medicare Providers

1487800850 — MR. MIGUEL FLORES JR. L.I.S.A.C
Practice Location Address:

1910 N PAINTED HILLS RD
TUCSON, AZ
85745-1532

Practice Phone: 520-904-5431
Practice Fax: 520-207-0677

1194337568 — MYRNA DORAME ALF OWNER
Practice Location Address:

1532 S PERLMAN AVE
TUCSON, AZ
85710-8523

Practice Phone: 520-393-9389
Practice Fax: 520-741-1465

1538095856 — BRIELLE JEANETTE TOBIN DO
Practice Location Address:

3601 S 6TH AVE
TUCSON, AZ
85723-0001

Practice Phone: 520-792-1450
Practice Fax: 520-629-4631

1457283020 — JASON L CHEN MD
Practice Location Address:

3601 S 6TH AVE
TUCSON, AZ
85723-0001

Practice Phone: 520-792-1450
Practice Fax: 520-629-4631

1528906674 — CHOON SHAN LOO OD
Practice Location Address:

3601 S 6TH AVE
TUCSON, AZ
85723-0001

Practice Phone: 520-792-1450
Practice Fax:

1407545205 — DR. HOANG NHAT PHAM MD
Practice Location Address:

3601 S 6TH AVE
TUCSON, AZ
85723-0001

Practice Phone: 520-792-1450
Practice Fax: 520-629-4631

Directions to “ ALI LOIS ICENOGLE PHARMACIST” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.