Provider Demographics
NPI:1376387886
Name:TACONIC PHARMACY INC
Entity type:Organization
Organization Name:TACONIC PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CIARLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:914-245-3334
Mailing Address - Street 1:3659 LEE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1507
Mailing Address - Country:US
Mailing Address - Phone:914-245-3334
Mailing Address - Fax:914-245-4096
Practice Address - Street 1:3659 LEE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1507
Practice Address - Country:US
Practice Address - Phone:914-245-3334
Practice Address - Fax:914-245-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030654OtherNYS BOARD LICENSE NUMBER
NY03351622Medicaid