Provider Demographics
NPI:1184340606
Name:HOLMES, TREVOR DENNIS (RPH)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:DENNIS
Last Name:HOLMES
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 1:1671 HIGHWAY 71 E
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4314
Mailing Address - Country:US
Mailing Address - Phone:512-308-0234
Mailing Address - Fax:512-308-9752
Practice Address - Street 1:1671 HIGHWAY 71 E
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4314
Practice Address - Country:US
Practice Address - Phone:512-308-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty