Provider Demographics
NPI:1750676821
Name:LATCHMINARAIN, TREVOR (RPH)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:LATCHMINARAIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 122ND ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2505
Mailing Address - Country:US
Mailing Address - Phone:917-416-0496
Mailing Address - Fax:
Practice Address - Street 1:6656 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2531
Practice Address - Country:US
Practice Address - Phone:718-446-6656
Practice Address - Fax:718-458-6656
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist