Provider Demographics
NPI:1083917660
Name:TRIUMPH PHARMACY LLC
Entity Type:Organization
Organization Name:TRIUMPH PHARMACY LLC
Other - Org Name:TRIUMPH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:281-687-4695
Mailing Address - Street 1:7030 FM 1488 RD # 110
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4774
Mailing Address - Country:US
Mailing Address - Phone:281-252-4200
Mailing Address - Fax:281-252-4201
Practice Address - Street 1:7030 FM 1488 RD # 110
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4774
Practice Address - Country:US
Practice Address - Phone:281-252-4200
Practice Address - Fax:281-252-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX272873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128089OtherPK
TX146312Medicaid