Provider Demographics
NPI:1851610802
Name:TRILOGY PHARMACY
Entity Type:Organization
Organization Name:TRILOGY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-248-7445
Mailing Address - Street 1:3824 CEDAR SPRINGS RD # 433
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4136
Mailing Address - Country:US
Mailing Address - Phone:469-248-7445
Mailing Address - Fax:214-206-9073
Practice Address - Street 1:2603 OAK LAWN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4021
Practice Address - Country:US
Practice Address - Phone:469-248-7445
Practice Address - Fax:214-206-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX269423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26942OtherTEXAS STATE BOARD OF PHARMACY