Provider Demographics
NPI:1407279797
Name:LAWRENCE, TREVOR WINSLOW (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:WINSLOW
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 N DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201
Mailing Address - Country:US
Mailing Address - Phone:480-962-4033
Mailing Address - Fax:480-962-4039
Practice Address - Street 1:857 N DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7582
Practice Address - Country:US
Practice Address - Phone:480-962-4033
Practice Address - Fax:480-962-4039
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist