Ickes Drug Store

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP411115L Issued in PA

Legal business name

ICKES DRUG STORE

Practice address

122 S Juliana St
Bedford, PA 15522-1301

Phone

(814) 623-5615

Fax

(814) 623-1465

NPI assigned

Dec 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Ickes

Title

Owner

Phone

(814) 623-5615

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• ICKES DRUG STORE Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482278400000",
    "number": "1023178266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 S JULIANA ST",
            "city": "BEDFORD",
            "state": "PA",
            "postal_code": "155221301",
            "telephone_number": "814-623-5615",
            "fax_number": "814-623-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 S JULIANA ST",
            "city": "BEDFORD",
            "state": "PA",
            "postal_code": "155221301",
            "telephone_number": "814-623-5615",
            "fax_number": "814-623-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICKES DRUG STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2016-12-21",
        "status": "A",
        "authorized_official_last_name": "ICKES",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-623-5615"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP411115L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001072318001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2085756",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICKES DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Huntingdon-Bedford-Fulton Area Agency on Aging
• Hyndman Area Health Center, Inc
• Hyndman Area Health Center, Inc
• Hyndman Area Health Center, Inc.
• Essam Naguib Ibrahim, D.M.D.
• Carol Lee Ickes
• Robyn Faith Isgan, DPT
• Shaylee Breanne Jackson
• Melinda Sue Jacobs, LSW
• Janidlo Optometry PC

• All providers in Bedford, PA
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.