Healthcare Provider Details

I. General information

NPI: 1427194042
Provider Name (Legal Business Name): TRESPHARM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 FARENHOLT AVE STE 101
TAMUNING GU
96913-3203
US

IV. Provider business mailing address

PO BOX 10600
TAMUNING GU
96931-0600
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-1193
  • Fax: 671-647-1194
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY045
License Number StateGU

VIII. Authorized Official

Name: YOUNG PARK
Title or Position: PRESIDENT
Credential:
Phone: 671-647-1193