Provider Demographics
NPI:1427045061
Name:PILGRIM PHARMACY INC
Entity Type:Organization
Organization Name:PILGRIM PHARMACY INC
Other - Org Name:PILGRIM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-823-1085
Mailing Address - Street 1:2941 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4534
Mailing Address - Country:US
Mailing Address - Phone:718-828-0498
Mailing Address - Fax:718-828-7491
Practice Address - Street 1:2941 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4534
Practice Address - Country:US
Practice Address - Phone:718-828-0498
Practice Address - Fax:718-828-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X, 3336S0011X
NY0154693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2069248OtherPK
NY00265756Medicaid
NY00265756Medicaid