Icp Holdings, LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

ICP HOLDINGS, LLC

Practice address

13141 N Dale Mabry Hwy Ste E
Tampa, FL 33618-2443

Phone

(813) 961-8798

Fax

(813) 961-9800

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Authorized official

Name

Charles Gaetano

Title

Owner

Phone

(404) 815-1610

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carrollwood Compounding Center Doing business as

Tax ID family

Carrollwood Compounding Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Icp Holdings, LLC

  • Compounding Pharmacy
  • Sandy Springs, GA
  • NPI 1184175523
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nichole Lynn Feagin, PHARMD

  • Pharmacist
  • Sandy Springs, GA
  • NPI 1306145446
  NPD
• Michelle L Alfonso, PHARMD

  • Pharmacist
  • Tampa, FL
  • NPI 1477622843
  NPD (past)
• Matthew Daniel Fucarino, MD

  • Emergency Medicine Physician
  • Plant City, FL
  • NPI 1750516761
  NPD (past)
• Christi Jean Griffith, PHARM. D.

  • Pharmacist
  • Tampa, FL
  • NPI 1013088038
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1053331850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13141 N DALE MABRY HWY STE E",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182443",
            "telephone_number": "813-961-8798",
            "fax_number": "813-961-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13141 N DALE MABRY HWY STE E",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182443",
            "telephone_number": "813-961-8798",
            "fax_number": "813-961-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICP HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "GAETANO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-815-1610"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BOARD OF PHARMACY",
            "identifier": "PH34126",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carrollwood Compounding Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yasmine Ibrahim, MD
• Icare Tampa, LLC
• Amy Michelle Ice, MA, CRC
• Tara Marie Ice, NNP
• Reem Ichoa, DO
• Idea Public Schools Florida
• Ideal Body Institute Tampa ASC LLC
• Ideal Body Institute Tampa, LLC
• Ideal Dental Carrollwood PLLC
• Ideal Dental of Westchase Florida PLLC

• Compounding Pharmacy in Tampa, FL
• Providers in Tampa, FL by specialty
• Compounding Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; 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.