MEDICARE: MR. BRIAN F PELLEGRINO RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP039964L	PA

General Provider Information

NPI Number	:	1104930718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN F PELLEGRINO RPH

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:	314 WATER STREET
City	:	EAST BRADY
State	:	PA
Zip	:	16028-0307
Country	:	US
Telephone Number	:	724-526-3110
Fax Number	:	724-526-3044

Provider Business Practice Location Address
First Line	:	7 WATER STREET
Second Line	:
City	:	EAST BRADY
State	:	PA
Zip	:	16028-0307
Country	:	US
Telephone Number	:	724-526-3110
Fax Number	:	724-526-3044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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