Healthcare Provider Details

I. General information

NPI: 1356502173
Provider Name (Legal Business Name): TRINITY PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 01/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD SUITE 240
SAN ANTONIO TX
78211-3758
US

IV. Provider business mailing address

PO BOX 9830
SALT LAKE CITY UT
84109-9830
US

V. Phone/Fax

Practice location:
  • Phone: 210-927-4744
  • Fax: 210-927-4003
Mailing address:
  • Phone: 801-716-4824
  • Fax: 801-716-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number26050
License Number StateTX

VIII. Authorized Official

Name: LARRY OLIVER
Title or Position: OWNER
Credential: RPH
Phone: 210-342-9481