MEDICARE: TRELLES PHARMACY MANAGEMENT, 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	332B00000X	Durable Medical Equipment & Medical Supplies	PH15867	FL

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	:	1659452050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRELLES PHARMACY MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	3501 RIGA BLVD
Second Line	:	SUITE 300
City	:	TAMPA
State	:	FL
Zip	:	33619-1333
Country	:	US
Telephone Number	:	813-662-1153
Fax Number	:	813-932-1259

Provider Business Practice Location Address
First Line	:	3501 RIGA BLVD
Second Line	:	SUITE 300
City	:	TAMPA
State	:	FL
Zip	:	33619-1333
Country	:	US
Telephone Number	:	813-662-1153
Fax Number	:	813-932-1259

Authorized Official
Title or Position	:	BUSINESS SERVICES MANAGER
Name	:	MRS. CHRISTINE WILLIAMS
Credential	:
Telephone Number	:	813-662-1153

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/22/2020

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