Provider Demographics
NPI:1790106854
Name:TRIXICORP
Entity Type:Organization
Organization Name:TRIXICORP
Other - Org Name:CHANE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:EZEOKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:615-948-1695
Mailing Address - Street 1:2510 MURFREESBORO PIKE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3582
Mailing Address - Country:US
Mailing Address - Phone:615-953-2402
Mailing Address - Fax:615-953-2507
Practice Address - Street 1:2510 MURFREESBORO PIKE
Practice Address - Street 2:SUITE 9
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3582
Practice Address - Country:US
Practice Address - Phone:615-948-1695
Practice Address - Fax:615-953-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045450Medicaid