Healthcare Provider Details

I. General information

NPI: 1386775484
Provider Name (Legal Business Name): TRINITY SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 GAUSE BLVD E STE F
SLIDELL LA
70461-4247
US

IV. Provider business mailing address

2800 GAUSE BLVD E STE F
SLIDELL LA
70461-4247
US

V. Phone/Fax

Practice location:
  • Phone: 985-641-4252
  • Fax: 985-641-5123
Mailing address:
  • Phone: 985-641-4252
  • Fax: 985-641-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.005754-IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TOMMY MORRIS
Title or Position: OWNER
Credential: PHD, RPH
Phone: 504-723-2551