Provider Demographics
NPI:1487915856
Name:TRISONS PHARMACY LLC
Entity type:Organization
Organization Name:TRISONS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANZANESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-472-6561
Mailing Address - Street 1:107 RUTGERS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1725
Mailing Address - Country:US
Mailing Address - Phone:484-472-6561
Mailing Address - Fax:484-472-6562
Practice Address - Street 1:107 RUTGERS AVE # S-1
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1731
Practice Address - Country:US
Practice Address - Phone:484-472-6561
Practice Address - Fax:484-472-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 333600000X
PAPP4822873336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3997472OtherNCPDP PROVIDER IDENTIFICATION NUMBER