Provider Demographics
NPI:1407252869
Name:TRINITY RESOURCES GROUP, INC
Entity Type:Organization
Organization Name:TRINITY RESOURCES GROUP, INC
Other - Org Name:SUPERIOR LANE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:240-334-2546
Mailing Address - Street 1:3327 SUPERIOR LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1922
Mailing Address - Country:US
Mailing Address - Phone:240-334-2546
Mailing Address - Fax:240-334-2624
Practice Address - Street 1:3327 SUPERIOR LN
Practice Address - Street 2:SUITE 205
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1922
Practice Address - Country:US
Practice Address - Phone:240-334-2546
Practice Address - Fax:240-334-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy