Provider Demographics
NPI:1659452050
Name:TRELLES PHARMACY MANAGEMENT, INC.
Entity Type:Organization
Organization Name:TRELLES PHARMACY MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-662-1153
Mailing Address - Street 1:3501 RIGA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1333
Mailing Address - Country:US
Mailing Address - Phone:813-662-1153
Mailing Address - Fax:813-932-1259
Practice Address - Street 1:3501 RIGA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1333
Practice Address - Country:US
Practice Address - Phone:813-662-1153
Practice Address - Fax:813-932-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH15867332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106362600-01Medicaid