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General NPI Number Information
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NPI Number | 1992577928
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Entity Type | Organization
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Legal Business Name | TRIA PHARMACY LLC
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 7687 WASHINTON AVE S
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City | EDINA
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State | MN
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Zip | 55439
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Country | US
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Telephone | 952-836-5866
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Fax |
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Provider Business Mailing Address
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Address Line | 7687 WASHINTON AVE S
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City | EDINA
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State | MN
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Zip | 55439
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Country | US
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Telephone | 952-836-5866
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. AHMEDFOWZ MOHAMED OSMAN
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Credential | RPH
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Telephone | 952-836-5866
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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