Provider Demographics
NPI:1467938787
Name:MULLINS, TREVOR JACOB (PHARMD)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JACOB
Last Name:MULLINS
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 1:4542 HIGHWAY 343
Mailing Address - Street 2:
Mailing Address - City:MC ROBERTS
Mailing Address - State:KY
Mailing Address - Zip Code:41835-9061
Mailing Address - Country:US
Mailing Address - Phone:606-832-2879
Mailing Address - Fax:
Practice Address - Street 1:2300 KY-15
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858
Practice Address - Country:US
Practice Address - Phone:606-632-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty