Provider Demographics
NPI:1326830688
Name:PELLEGRINO, CARLA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 PECONIC BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NY
Mailing Address - Zip Code:11948-1843
Mailing Address - Country:US
Mailing Address - Phone:516-242-2253
Mailing Address - Fax:516-242-2253
Practice Address - Street 1:5225 PECONIC BAY BLVD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NY
Practice Address - Zip Code:11948-1843
Practice Address - Country:US
Practice Address - Phone:516-242-2253
Practice Address - Fax:516-242-2253
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist