Healthcare Provider Details

I. General information

NPI: 1649723909
Provider Name (Legal Business Name): I.C. PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 35TH ST SUITE 4BSW, MAILBOX 28
BROOKLYN NY
11232
US

IV. Provider business mailing address

34 35TH ST STE 4BSW
BROOKLYN NY
11232-2021
US

V. Phone/Fax

Practice location:
  • Phone: 347-554-2663
  • Fax: 347-223-5966
Mailing address:
  • Phone: 855-745-5725
  • Fax: 603-935-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TANVI JAYANTI PATEL
Title or Position: VICE PRESIDENT
Credential:
Phone: 855-745-5725