Provider Demographics
NPI:1265017685
Name:HOLY TRINITY PHARMACY LTC LLC
Entity Type:Organization
Organization Name:HOLY TRINITY PHARMACY LTC LLC
Other - Org Name:HOLY TRINITY PHARMACY, LTC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:SAMIR
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:727-312-4384
Mailing Address - Street 1:10900 STATE ROAD 54 STE 102B
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2267
Mailing Address - Country:US
Mailing Address - Phone:727-312-4384
Mailing Address - Fax:727-312-4605
Practice Address - Street 1:10900 STATE ROAD 54 STE 102B
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-2267
Practice Address - Country:US
Practice Address - Phone:727-312-4384
Practice Address - Fax:727-312-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105889100Medicaid