Healthcare Provider Details

I. General information

NPI: 1497393524
Provider Name (Legal Business Name): HOLY TRINITY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 STATE ROAD 54 STE 102
TRINITY FL
34655-2267
US

IV. Provider business mailing address

10900 STATE ROAD 54 STE 102
TRINITY FL
34655-2267
US

V. Phone/Fax

Practice location:
  • Phone: 727-312-4384
  • Fax: 727-312-4605
Mailing address:
  • Phone: 551-221-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NANCY S AWAD
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 551-221-5670