Provider Demographics
NPI:1649723909
Name:I.C. PHARMACY LLC
Entity type:Organization
Organization Name:I.C. PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-745-5725
Mailing Address - Street 1:34 35TH ST
Mailing Address - Street 2:SUITE 4BSW, MAILBOX 28
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2021
Mailing Address - Country:US
Mailing Address - Phone:347-554-2663
Mailing Address - Fax:347-223-5966
Practice Address - Street 1:34 35TH ST
Practice Address - Street 2:SUITE 4BSW, MAILBOX 28
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232
Practice Address - Country:US
Practice Address - Phone:347-554-2663
Practice Address - Fax:347-223-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy