Provider Demographics
NPI:1912226408
Name:STEWART, TRINA LORRAINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRINA
Middle Name:LORRAINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ARMOUR DR NE
Mailing Address - Street 2:APT. 11106
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3933
Mailing Address - Country:US
Mailing Address - Phone:504-400-9245
Mailing Address - Fax:
Practice Address - Street 1:965 N HAIRSTON RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2880
Practice Address - Country:US
Practice Address - Phone:770-413-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist