Healthcare Provider Details

I. General information

NPI: 1154414597
Provider Name (Legal Business Name): TRINITY COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 OAK ST
EUGENE OR
97401-4790
US

IV. Provider business mailing address

1515 OAK ST
EUGENE OR
97401-4790
US

V. Phone/Fax

Practice location:
  • Phone: 541-684-9352
  • Fax: 541-684-0858
Mailing address:
  • Phone: 541-684-9352
  • Fax: 541-684-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPMP-792
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP-0001564
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHNR.FO.60312318
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHAO1179
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier227829
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier2079479
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 3
Identifier1581038
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 4
Identifier2096620
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: ANNE HARTHMAN
Title or Position: CHIEF CLINICAL OFFICER, PIC
Credential:
Phone: 541-684-9352