Provider Demographics
NPI:1497393524
Name:HOLY TRINITY PHARMACY, LLC
Entity Type:Organization
Organization Name:HOLY TRINITY PHARMACY, LLC
Other - Org Name:HOLY TRINITY PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:551-221-5670
Mailing Address - Street 1:10900 STATE ROAD 54 STE 102
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:551-221-5670
Mailing Address - Fax:
Practice Address - Street 1:10900 STATE ROAD 54 STE 102
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:2019-12-19
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy