=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124480967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARCHMONT PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2016
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2141 PALMER AVE
-----------------------------------------------------
City | LARCHMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10538-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-341-1900
-----------------------------------------------------
Fax | 914-341-1901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2141 PALMER AVE
-----------------------------------------------------
City | LARCHMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10538-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-341-1900
-----------------------------------------------------
Fax | 914-341-1907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MR. ANTHONY JOHN CIARLETTA
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 914-341-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 034528
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------