Provider Demographics
NPI:1275922072
Name:TRILLIUM HEALTH, INC.
Entity Type:Organization
Organization Name:TRILLIUM HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PHARMACY SERVCIES
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MALAHOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:585-210-4152
Mailing Address - Street 1:170 SCIENCE PARKWAY
Mailing Address - Street 2:ATTN: PHARMACY ADMINISTRATION
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4251
Mailing Address - Country:US
Mailing Address - Phone:855-707-4237
Mailing Address - Fax:877-616-3088
Practice Address - Street 1:170 SCIENCE PKWY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4251
Practice Address - Country:US
Practice Address - Phone:585-714-9000
Practice Address - Fax:585-545-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FL293943336C0003X, 3336C0003X
NY033316333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04150914Medicaid
2148968OtherPK
7507130001Medicare NSC