MEDICARE: TRINITY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	0201004398	VA

General Provider Information

NPI Number	:	1275811218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY PHARMACY LLC

Provider Business Mailing Address
First Line	:	396 E BURWELL ST
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-4329
Country	:	US
Telephone Number	:	540-444-7383
Fax Number	:

Provider Business Practice Location Address
First Line	:	396 E BURWELL ST
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-4329
Country	:	US
Telephone Number	:	540-444-7383
Fax Number	:

Authorized Official
Title or Position	:	AUTH MEMBER
Name	:	PUNITA KHARA
Credential	:
Telephone Number	:	908-380-9232

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	08/01/2011

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