Healthcare Provider Details

I. General information

NPI: 1164872503
Provider Name (Legal Business Name): SALVATORE PELLEGRINO PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

2568 YATES AVE
BRONX NY
10469-5311
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-2838
  • Fax:
Mailing address:
  • Phone: 917-941-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: