Provider Demographics
NPI:1790159085
Name:TRINITY SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:TRINITY SPECIALTY PHARMACY LLC
Other - Org Name:RSVP RX #300
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RECORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-279-4501
Mailing Address - Street 1:6300 BRIDGE POINT PKWY
Mailing Address - Street 2:BLDG 3 STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-5073
Mailing Address - Country:US
Mailing Address - Phone:512-279-4501
Mailing Address - Fax:844-965-9405
Practice Address - Street 1:13615 BRUCE B DOWNS BLVD
Practice Address - Street 2:STE 111
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4607
Practice Address - Country:US
Practice Address - Phone:855-254-8529
Practice Address - Fax:855-254-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FL295253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155553OtherPK