Provider Demographics
NPI:1467747006
Name:TREVINO, JESS MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:MICHAEL
Last Name:TREVINO
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 1:1701 S YALE AVE
Mailing Address - Street 2:T-0019
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-6221
Mailing Address - Country:US
Mailing Address - Phone:918-293-0193
Mailing Address - Fax:
Practice Address - Street 1:1701 S YALE AVE
Practice Address - Street 2:T-0019
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-6221
Practice Address - Country:US
Practice Address - Phone:918-293-0193
Practice Address - Fax:918-293-0196
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist