Provider Demographics
NPI:1902093214
Name:PELLEGRINO, BONNIE SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:SUE
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 1:2453 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2245
Mailing Address - Country:US
Mailing Address - Phone:716-876-3097
Mailing Address - Fax:
Practice Address - Street 1:2453 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2245
Practice Address - Country:US
Practice Address - Phone:716-876-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist