Organization
ICP HOLDINGS, LLC
Active
Other names
Carrollwood Compounding Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES GAETANO (OWNER)
(404) 815-1610
Entity
Organization
Contact information
Practice address
13141 N DALE MABRY HWY STE E, TAMPA, FL 33618-2443
(813) 961-8798
(813) 961-9800
Mailing address
13141 N DALE MABRY HWY STE E, TAMPA, FL 33618-2443
(813) 961-8798
(813) 961-9800
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH34126
FLORIDA BOARD OF PHARMACY
FL
Enumeration date
07/21/2006
Last updated
03/27/2025
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