Provider Demographics
NPI:1639486491
Name:TRINITY PHARMACY ENTERPRISE, LLC
Entity Type:Organization
Organization Name:TRINITY PHARMACY ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLEMENTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NANJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-949-0994
Mailing Address - Street 1:3003 HOPELAND DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6003
Mailing Address - Country:US
Mailing Address - Phone:678-949-0994
Mailing Address - Fax:
Practice Address - Street 1:3379 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-1711
Practice Address - Country:US
Practice Address - Phone:678-705-5690
Practice Address - Fax:678-705-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE009673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty