Provider Demographics
NPI:1942756341
Name:JUTH, TREVOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:JUTH
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 1:2312 TULIP WAY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-0923
Mailing Address - Country:US
Mailing Address - Phone:720-684-9499
Mailing Address - Fax:
Practice Address - Street 1:551 S HOVER ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7920
Practice Address - Country:US
Practice Address - Phone:720-864-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0021457OtherCOLORADO DORA