Provider Demographics
NPI:1386707909
Name:TRNITY HEALTHCARE CORP
Entity type:Organization
Organization Name:TRNITY HEALTHCARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBI
Authorized Official - Middle Name:
Authorized Official - Last Name:ENEMCHUKWY
Authorized Official - Suffix:
Authorized Official - Credentials:PHRM
Authorized Official - Phone:407-366-2677
Mailing Address - Street 1:85 GENEVA DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 GENEVA DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6757
Practice Address - Country:US
Practice Address - Phone:407-366-2677
Practice Address - Fax:407-366-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH117043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1067087OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0634060001Medicare ID - Type Unspecified