Provider Demographics
NPI:1275164881
Name:PRICE, TREVOR WILLIAM
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:WILLIAM
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W 39TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4928
Mailing Address - Country:US
Mailing Address - Phone:203-993-4082
Mailing Address - Fax:
Practice Address - Street 1:401 W 39TH ST APT 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4928
Practice Address - Country:US
Practice Address - Phone:203-993-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician