MEDICARE: TRINITY DRUG INC

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	019537	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578665212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY DRUG INC

Provider Business Mailing Address
First Line	:	45 LUDLOW ST
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10705-1947
Country	:	US
Telephone Number	:	914-965-5275
Fax Number	:	914-965-2380

Provider Business Practice Location Address
First Line	:	45 LUDLOW ST
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10705-1947
Country	:	US
Telephone Number	:	914-965-5275
Fax Number	:	914-965-2380

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAE HAN SONG
Credential	:
Telephone Number	:	914-965-5275

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	08/22/2020

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Directions to “TRINITY DRUG INC ” Practice Location

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