Provider Demographics
NPI:1790785293
Name:TRELLES PHARMACY MANAGEMENT INC.
Entity Type:Organization
Organization Name:TRELLES PHARMACY MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLEAVER
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-662-1153
Mailing Address - Street 1:P.O. BOX 89039-0400
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33689-9039
Mailing Address - Country:US
Mailing Address - Phone:813-662-1153
Mailing Address - Fax:813-657-3475
Practice Address - Street 1:3501 RIGA BLVD
Practice Address - Street 2:SUITE 300A
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:813-657-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH15867333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083055OtherNCPDP
FL1205310001Medicare ID - Type Unspecified