Provider Demographics
NPI:1639488315
Name:TRINITY PHARMACY INC.
Entity Type:Organization
Organization Name:TRINITY PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONIA
Authorized Official - Middle Name:NKEONYEASOA
Authorized Official - Last Name:FREGENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:770-726-7270
Mailing Address - Street 1:3600 CHEROKEE STREET NW
Mailing Address - Street 2:SUIT 120
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2027
Mailing Address - Country:US
Mailing Address - Phone:770-726-7270
Mailing Address - Fax:678-402-1916
Practice Address - Street 1:3600 CHEROKEE ST NW
Practice Address - Street 2:SUIT 120
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2027
Practice Address - Country:US
Practice Address - Phone:770-726-7270
Practice Address - Fax:678-402-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0096963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy