Healthcare Provider Details

I. General information

NPI: 1841697489
Provider Name (Legal Business Name): TRISYS MANAGEMENT GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 MADERA RD # N-182
SIMI VALLEY CA
93065-3077
US

IV. Provider business mailing address

1464 MADERA RD # N-182
SIMI VALLEY CA
93065-3077
US

V. Phone/Fax

Practice location:
  • Phone: 805-416-1648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. CORT COLBERT
Title or Position: MANAGER
Credential:
Phone: 805-416-1648