Provider Demographics
NPI:1447618830
Name:TRINH PHARMACY
Entity Type:Organization
Organization Name:TRINH PHARMACY
Other - Org Name:TRINH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-782-5823
Mailing Address - Street 1:1530 CAMPBELL LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4167
Mailing Address - Country:US
Mailing Address - Phone:270-782-5823
Mailing Address - Fax:270-936-7365
Practice Address - Street 1:1530 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4167
Practice Address - Country:US
Practice Address - Phone:270-782-5823
Practice Address - Fax:270-936-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP077493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100398570Medicaid
2157853OtherPK
KY7100398570Medicaid