Provider Demographics
NPI:1881752905
Name:TRILLIUM HEALTH, INC.
Entity type:Organization
Organization Name:TRILLIUM HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PHARMACY SERVICES
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 1:259 MONROE AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3632
Practice Address - Country:US
Practice Address - Phone:585-241-9000
Practice Address - Fax:585-454-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.020552333600000X
FL287803336C0003X
NHNR15403336C0003X
RIPHN113533336C0003X
PANP0010173336C0003X
NJ28RO001688003336C0003X
NC134423336S0011X
NY0268603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03007518Medicaid
2063512OtherPK
NY03007518Medicaid