Provider Demographics
NPI:1215799275
Name:TRINITY MED RX, LLC
Entity type:Organization
Organization Name:TRINITY MED RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TANYEL
Authorized Official - Middle Name:TORRELL
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:769-242-0673
Mailing Address - Street 1:1620 HIGHWAY 11 N STE F
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2070
Mailing Address - Country:US
Mailing Address - Phone:769-242-0673
Mailing Address - Fax:769-242-0673
Practice Address - Street 1:1620 HIGHWAY 11 N STE F
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2070
Practice Address - Country:US
Practice Address - Phone:769-242-0673
Practice Address - Fax:769-242-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy