Organization
ICON HEALTH SCIENCE
Active
Other names
BODY AND PAIN
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IKECHUKWU (IKAY) KANAYO ENU M.D. (MEDICAL DIRECTOR)
(617) 905-4430
Entity
Organization
Contact information
Practice address
40 RICHARDS AVE, 3RD FLOOR, NORWALK, CT 06854-2319
(800) 243-8370
(888) 374-0626
Mailing address
40 RICHARDS AVE, 3RD FLOOR, NORWALK, CT 06854-2319
(800) 243-8370
(888) 374-0626
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
D0067749
MD
3336M0002X
Mail Order Pharmacy
Primary
D0067749
MD
3336S0011X
Specialty Pharmacy
D0067749
MD
Other
Enumeration date
03/17/2017
Last updated
03/17/2017
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