Provider Demographics
NPI:1770815490
Name:PELLEGRINO, DONNA MARIA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIA
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2659
Mailing Address - Country:US
Mailing Address - Phone:516-825-0396
Mailing Address - Fax:
Practice Address - Street 1:4 TIMES SQ
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6518
Practice Address - Country:US
Practice Address - Phone:646-366-8047
Practice Address - Fax:646-366-8118
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist