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General NPI Number Information
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NPI Number | 1558771709
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Entity Type | Organization
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Legal Business Name | TRIM NUTRITION PHARMACY
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 22079 US HIGHWAY 19 N
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City | CLEARWATER
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State | FL
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Zip | 33765-2364
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Country | US
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Telephone | 727-399-6468
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 N HERCULES AVE
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City | CLEARWATER
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State | FL
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Zip | 33765-1921
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Country | US
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Telephone | 727-399-6468
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | INA MCCORMICK
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Credential |
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Telephone | 727-399-6468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PH27760
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License Number State | FL
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