MEDICARE: ICY PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	033720	NY

General Provider Information

NPI Number	:	1740662600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICY PHARMACY INC

Provider Business Mailing Address
First Line	:	1340 BUSHWICK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-3962
Country	:	US
Telephone Number	:	718-455-5080
Fax Number	:	718-455-0050

Provider Business Practice Location Address
First Line	:	1340 BUSHWICK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-3962
Country	:	US
Telephone Number	:	718-455-5080
Fax Number	:	718-455-0050

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES IGBODO
Credential	:
Telephone Number	:	718-455-5080

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	05/07/2026

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Directions to “ICY PHARMACY INC ” Practice Location

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