Provider Demographics
NPI:1144335340
Name:LIFECHEK TRINITY LLC
Entity type:Organization
Organization Name:LIFECHEK TRINITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-232-3940
Mailing Address - Street 1:507 S ROBB ST STE B
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-7618
Mailing Address - Country:US
Mailing Address - Phone:936-594-3593
Mailing Address - Fax:936-594-9681
Practice Address - Street 1:507 S ROBB ST STE B
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-7618
Practice Address - Country:US
Practice Address - Phone:936-594-3593
Practice Address - Fax:936-594-9681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECHEK AUCHAN PARTNERS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX207153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX470989Medicaid
2096977OtherPK
2096977OtherPK
1208670005Medicare NSC