Provider Demographics
NPI:1720718562
Name:DEMASS, TREVOR LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:LEE
Last Name:DEMASS
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 1:82 S 1100 E STE 104
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1687
Mailing Address - Country:US
Mailing Address - Phone:801-521-6353
Mailing Address - Fax:801-521-6390
Practice Address - Street 1:82 S 1100 E STE 104
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1687
Practice Address - Country:US
Practice Address - Phone:801-521-6353
Practice Address - Fax:801-521-6390
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6312198-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist