NPIMap

Organization Active NPI

Trinity Pharmacy

  • Clinic Pharmacy
  • Tyler, TX
National Provider Identifier
1710040613
Registry record updated Feb 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
24082 Issued in TX
Legal business name
TRINITY PHARMACY
Practice address
520 E. Douglas
Tyler, TX 75702-7936
Phone
(903) 526-3784
NPI assigned
Dec 19, 2006
Last updated
Feb 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alex Hyuk Park, PHARMD
Title
Manager
Phone
(903) 526-3784

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 24082 TX Primary

Addresses

Primary practice location

520 E. Douglas
Tyler, TX 75702-7936

Mailing address

520 E. Douglas
Tyler, TX 75702-7936
Phone (903) 526-3784

Other identifiers 1

IdentifierTypeStateIssuer
145536MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Tyler Radiologist25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1710040613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E. DOUGLAS",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757027936",
            "telephone_number": "903-526-3784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E. DOUGLAS",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757027936",
            "telephone_number": "903-526-3784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "ALEX",
        "authorized_official_middle_name": "HYUK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "903-526-3784",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "TX",
            "license": "24082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145536",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.