Provider Demographics
NPI:1427484005
Name:TRINITY WAY PHARMACY, INC.
Entity type:Organization
Organization Name:TRINITY WAY PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOUSIF
Authorized Official - Middle Name:HABIB
Authorized Official - Last Name:KATTOULA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:619-933-4875
Mailing Address - Street 1:2650 JAMACHA RD. #147
Mailing Address - Street 2:PMB 111
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-933-4875
Mailing Address - Fax:
Practice Address - Street 1:9999 MIRA MESA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1006
Practice Address - Country:US
Practice Address - Phone:619-933-4875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04447-CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy