Provider Demographics
NPI:1780671974
Name:TROM ENTERPRISES, INC.
Entity Type:Organization
Organization Name:TROM ENTERPRISES, INC.
Other - Org Name:CARLTON'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEEPLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:706-695-4576
Mailing Address - Street 1:101 MURRAY PLAZA
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705
Mailing Address - Country:US
Mailing Address - Phone:706-695-4576
Mailing Address - Fax:706-695-6696
Practice Address - Street 1:101 MURRAY PLAZA
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705
Practice Address - Country:US
Practice Address - Phone:706-695-4576
Practice Address - Fax:706-695-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
GA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0002811CMedicaid
GA00022811CMedicaid
GAPHRE002530OtherGA STATE LIC
1124700OtherNCPDP
1124700OtherNCPDP