Provider Demographics
NPI:1578034096
Name:TRIPLE ALLIANCE PHARMACY, INC
Entity Type:Organization
Organization Name:TRIPLE ALLIANCE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TSEDALE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZERABRUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-525-1386
Mailing Address - Street 1:1819 WEST VIRGNIA AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-525-1386
Mailing Address - Fax:202-629-4543
Practice Address - Street 1:1819 WEST VIRGNIA AVENUE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:202-525-1386
Practice Address - Fax:202-629-4543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIPLE ALLINACE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC051743900Medicaid