MEDICARE: TRILOGY PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	26942	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26942	OTHER	TX	TEXAS STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1851610802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRILOGY PHARMACY

Provider Business Mailing Address
First Line	:	3824 CEDAR SPRINGS RD # 433
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4136
Country	:	US
Telephone Number	:	469-248-7445
Fax Number	:	214-206-9073

Provider Business Practice Location Address
First Line	:	2603 OAK LAWN AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4021
Country	:	US
Telephone Number	:	469-248-7445
Fax Number	:	214-206-9073

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	ANDREW J BAUMILLER
Credential	:
Telephone Number	:	469-248-7445

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	07/20/2011

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Directions to “TRILOGY PHARMACY ” Practice Location

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