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General NPI Number Information
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NPI Number | 1427484005
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Entity Type | Organization
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Legal Business Name | TRINITY WAY PHARMACY, INC.
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 9999 MIRA MESA BLVD SUITE 101
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City | SAN DIEGO
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State | CA
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Zip | 92131-1006
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Country | US
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Telephone | 619-933-4875
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 JAMACHA RD. #147 PMB 111
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City | EL CAJON
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State | CA
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Zip | 92108
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Country | US
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Telephone | 619-933-4875
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOUSIF HABIB KATTOULA
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Credential | PHARMD
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Telephone | 619-933-4875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 04447-CA
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License Number State | CA
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