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General NPI Number Information
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NPI Number | 1265729826
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Entity Type | Organization
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Legal Business Name | TRINITY PHARMACY INC
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 1335 S GRAND AVE
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City | GLENDORA
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State | CA
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Zip | 91740
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Country | US
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Telephone | 626-335-2700
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Fax | 626-335-2727
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Provider Business Mailing Address
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Address Line | 1335 S GRAND AVE
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City | GLENDORA
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State | CA
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Zip | 91740
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Country | US
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Telephone | 626-335-2700
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Fax | 626-335-2727
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | MR. JOHN ATALLA KOLTA
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Credential | PHARMACIST
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Telephone | 626-335-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY50657
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY50657
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License Number State | CA
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