Provider Demographics
NPI:1467236224
Name:HOFMAN, TREVOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:HOFMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 PORT SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-9536
Mailing Address - Country:US
Mailing Address - Phone:616-312-5289
Mailing Address - Fax:
Practice Address - Street 1:6790 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6860
Practice Address - Country:US
Practice Address - Phone:616-954-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315244387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist