Provider Demographics
NPI:1275032948
Name:TRIFECTA PHARMACY LLC
Entity Type:Organization
Organization Name:TRIFECTA PHARMACY LLC
Other - Org Name:WOODLANDS COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-504-9910
Mailing Address - Street 1:9303 PINECROFT STE 300
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-446-2952
Mailing Address - Fax:281-331-6109
Practice Address - Street 1:9303 PINECROFT STE 300
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-446-2952
Practice Address - Fax:281-331-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX317843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175429OtherPK