Healthcare Provider Details

I. General information

NPI: 1477178614
Provider Name (Legal Business Name): CORY PETRETTI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 STATE ROUTE 32
NEW WINDSOR NY
12553-8347
US

IV. Provider business mailing address

31 LEROY AVE
VALHALLA NY
10595-1421
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-5292
  • Fax:
Mailing address:
  • Phone: 914-879-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI064326-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: