Perigon Pharmacy 360, LLC

Primary specialty

Specialty PharmacyTaxonomy code 3336S0011X

Legal business name

PERIGON PHARMACY 360, LLC

Practice address

1120 Stevenson Mill Rd Ste 200
Coraopolis, PA 15108-2446

Phone

(412) 684-2500

Fax

(844) 582-5332

NPI assigned

Jun 24, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Genese Marie Hendrickson

Title

Chief Executive Officer

Phone

(412) 684-2500

Specialties & licenses 2

Addresses

Other identifiers 8

Other names 1

• Valeda Rx LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Tax ID family

Perigon Pharmacy 360 LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Perigon Pharmacy 360, LLC

  • Long Term Care Pharmacy
  • Coraopolis, PA
  • NPI 1417642513
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anthony Dalesio, PHARMD

  • Pharmacist
  • Coraopolis, PA
  • NPI 1043926264
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1669823266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 STEVENSON MILL RD STE 200",
            "city": "CORAOPOLIS",
            "state": "PA",
            "postal_code": "151082446",
            "telephone_number": "844-698-2533",
            "fax_number": "844-582-5332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 STEVENSON MILL RD STE 200",
            "city": "CORAOPOLIS",
            "state": "PA",
            "postal_code": "151082446",
            "telephone_number": "412-684-2500",
            "fax_number": "844-582-5332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIGON PHARMACY 360, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-24",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "GENESE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "412-684-2500"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1032363790001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669823266",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689851",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7P2679",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "564121700",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2111445",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160783",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "656739",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valeda Rx LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Rachael Perlick, MA, LPC
• Lee Ann Perry, OTR
• Lisa Maria Pettko-Self, PHARMD

• All providers in Coraopolis, PA
• Specialty Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.