Healthcare Provider Details

I. General information

NPI: 1861200776
Provider Name (Legal Business Name): AMERICAN ICT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 BENNING RD NE STE 101
WASHINGTON DC
20002-4571
US

IV. Provider business mailing address

1647 BENNING RD NE STE 101
WASHINGTON DC
20002-4571
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-7877
  • Fax: 202-388-3157
Mailing address:
  • Phone: 202-399-7877
  • Fax: 202-388-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ADEKOLA BALOGUN
Title or Position: PRESIDENT
Credential:
Phone: 443-208-5818