Provider Demographics
NPI:1790965333
Name:TARQUINIO, AGAPITO (RPH CDE)
Entity Type:Individual
Prefix:MR
First Name:AGAPITO
Middle Name:
Last Name:TARQUINIO
Suffix:
Gender:M
Credentials:RPH CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-5000
Mailing Address - Country:US
Mailing Address - Phone:518-399-0054
Mailing Address - Fax:
Practice Address - Street 1:290 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-5000
Practice Address - Country:US
Practice Address - Phone:518-399-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0330951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist