Provider Demographics
NPI:1720358997
Name:TRINITY MEDICAL PHARMACY,LLC
Entity Type:Organization
Organization Name:TRINITY MEDICAL PHARMACY,LLC
Other - Org Name:TRINITY MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRUTIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-966-0177
Mailing Address - Street 1:9332 STATE ROAD 54
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1808
Mailing Address - Country:US
Mailing Address - Phone:813-966-0177
Mailing Address - Fax:813-948-6309
Practice Address - Street 1:9332 STATE ROAD 54
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1808
Practice Address - Country:US
Practice Address - Phone:813-966-0177
Practice Address - Fax:813-948-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25693332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7093950001Medicare NSC