Healthcare Provider Details

I. General information

NPI: 1093776825
Provider Name (Legal Business Name): I C P INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W COUNTY ROAD 54
TIFFIN OH
44883-7723
US

IV. Provider business mailing address

1815 W COUNTY RD 54
TIFFIN OH
44883-9667
US

V. Phone/Fax

Practice location:
  • Phone: 800-228-8278
  • Fax: 419-447-1878
Mailing address:
  • Phone: 419-447-6216
  • Fax: 419-447-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number020434650
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: DANIEL JAMES SEIGHMAN
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 216-310-2460