Provider Demographics
NPI:1710683123
Name:PILGRIM PHARMACY INC
Entity Type:Organization
Organization Name:PILGRIM PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VITO
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:718-823-1085
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:718-823-1085
Practice Address - Fax:718-828-7491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PILGRIM PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-07
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00265756Medicaid