Ali Lois Icenogle, PHARMACIST

Primary specialty

PharmacistTaxonomy code 183500000X

License

PH61056519 Issued in WA

Practice address

3601 S 6TH Ave
Tucson, AZ 85723-1532

Phone

(520) 792-1450

NPI assigned

Nov 13, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bob Johnsons Pharmacy

  • Community/Retail Pharmacy
  • Seattle, WA
  • NPI 1932110434
  NPD (past)
• Bob Johnsons Pharmacy Inc

  • Long Term Care Pharmacy
  • Seattle, WA
  • NPI 1144945866
  NPD (past)

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1053824003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 W ORANGE GROVE RD UNIT 66",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857413417",
            "telephone_number": "480-789-9151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 S 6TH AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857231532",
            "telephone_number": "520-792-1450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1660 S Columbian Way",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981081532",
            "country_code": "US",
            "telephone_number": "206-277-4572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ICENOGLE",
        "first_name": "ALI",
        "middle_name": "LOIS",
        "credential": "PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-13",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH61056519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ic2 Therapy, PLLC.
• Icare Health Services LLC
• Icare Health Services LLC
• Icare Health Services LLC
• Jonathan Icely, DMD
• Carol L. Ickes, P.T.
• Ruru Idahosa, DO
• Ideal Health Services Group Inc
• Ideal Rehabilitation LLC
• Osahon Nekpen Idolor, MD

• Pharmacist in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Pharmacist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.