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Organization
ICP2 LLC
Active
Organization
ICP2 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIR TAMMOUS (OWNER)
(973) 809-2820
Entity
Organization
Contact information
Practice address
661MAIN STREET, PATERSON, NJ 07503
(973) 307-9000
(973) 754-0044
Mailing address
661MAIN STREET, PATERSON, NJ 07503
(973) 307-9000
(973) 754-0044
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
28RS00760400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176021
PK
—
Enumeration date
02/14/2018
Last updated
04/30/2018
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