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Icotadai Inc
Managed Care Organization Pharmacy in Riverton, Utah
NPI 1366586430

Icotadai Inc is a Managed Care Organization Pharmacy based in Riverton, UT and is specialized in Managed Care Organization Pharmacy. Icotadai Inc practices in Riverton, UT. The NPI Number for Icotadai Inc is 1366586430 and holds a License No. 64211071704 (Utah).

The current practice location address for Icotadai Inc is 2332 W 12600 S, Riverton, UT and can be reached out via phone at 801-253-6778 and via fax at 801-253-6779.

Location: 2332 W 12600 S, Riverton, UT, 84065-7161
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1366586430
Provider Name
Icotadai Inc
Credential
Provider Entity Type
Organization
Address
2332 W 12600 S, Riverton, UT, 84065-7161
Phone Number
801-253-6778
Fax Number
801-253-6779
Provider Enumeration Date
02/20/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
4610754 01 OTHER ID NUMBER-COMMERCIAL NUMBER
institution
Provider Business Practice Location Address Details
Address
2332 W 12600 S
City
Riverton
State
Utah
Zip
84065-7161
Phone Number
801-253-6778
Fax Number
801-253-6779
person
Provider Business Mailing Address Details
Address
2332 W 12600 S
City
Riverton
State
Utah
Zip
84065-7161
Phone Number
801-253-6778
Fax Number
801-253-6779
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Pharmacy
Speciality
Managed Care Organization Pharmacy
Taxonomy
3336M0003X
License No.
64211071704 (Utah)
Definition
A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's covered members only.
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