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General NPI Number Information
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NPI Number | 1316330772
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Entity Type | Organization
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Legal Business Name | TRINITY PHARMACY ENTERPRISE II LLC
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 3886 PRINCETON LAKES WAY SW 180
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City | ATLANTA
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State | GA
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Zip | 30331-5511
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Country | US
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Telephone | 404-343-1624
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 HOPELAND DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6003
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Country | US
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Telephone | 678-949-0994
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CLEMENTINE EBENYE NANJE
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Credential | PHARM D
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Telephone | 404-343-1624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHRE010129
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License Number State | GA
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