Organization
ICKES DRUG STORE
Active
Other names
ICKES DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ICKES (OWNER)
(814) 623-5615
Entity
Organization
Contact information
Practice address
122 S JULIANA ST, BEDFORD, PA 15522-1301
(814) 623-5615
(814) 623-1465
Mailing address
122 S JULIANA ST, BEDFORD, PA 15522-1301
(814) 623-5615
(814) 623-1465
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP411115L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001072318001
—
PA
01
—
2085756
PK
—
Enumeration date
12/11/2006
Last updated
12/21/2016
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