Provider Demographics
NPI:1700190139
Name:YANNACE, TREVOR PETER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:PETER
Last Name:YANNACE
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 1:15 GREENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6628
Mailing Address - Country:US
Mailing Address - Phone:516-884-8253
Mailing Address - Fax:
Practice Address - Street 1:15 GREENRIDGE DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-6628
Practice Address - Country:US
Practice Address - Phone:516-884-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist