Provider Demographics
NPI:1295336592
Name:TREVINO, DANIEL
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:TREVINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 HIGHWAY 83 SOUTH
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4401 HIGHWAY 83 SOUTH
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046
Practice Address - Country:US
Practice Address - Phone:956-727-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist