Provider Demographics
NPI:1568976421
Name:TRIUMPH PHARMACY SV, LLC
Entity Type:Organization
Organization Name:TRIUMPH PHARMACY SV, LLC
Other - Org Name:TRIUMPH PHARMACY SV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:SALINAS
Authorized Official - Last Name:HOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:281-687-4695
Mailing Address - Street 1:2255 E MOSSY OAKS RD STE 350
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1812
Mailing Address - Country:US
Mailing Address - Phone:281-288-4100
Mailing Address - Fax:281-288-4101
Practice Address - Street 1:2255 E MOSSY OAKS RD STE 350
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-1812
Practice Address - Country:US
Practice Address - Phone:281-288-4100
Practice Address - Fax:281-288-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31709333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31709OtherTEXAS STATE BOARD OF PHARMACY