Healthcare Provider Details

I. General information

NPI: 1548569098
Provider Name (Legal Business Name): TACONIC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 LEE RD
JEFFERSON VALLEY NY
10535-1507
US

IV. Provider business mailing address

3659 LEE RD
JEFFERSON VALLEY NY
10535-1507
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-3334
  • Fax: 914-245-4096
Mailing address:
  • Phone: 914-245-3334
  • Fax: 914-245-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number030654
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY CIARLETTA
Title or Position: VICE PRESIDENT
Credential: PHARMACIST
Phone: 914-779-5133