Provider Demographics
NPI:1801678933
Name:TREVINO, ISAIH COLE
Entity type:Individual
Prefix:
First Name:ISAIH
Middle Name:COLE
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 1:306 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-4420
Mailing Address - Country:US
Mailing Address - Phone:979-332-9295
Mailing Address - Fax:
Practice Address - Street 1:401 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-5767
Practice Address - Country:US
Practice Address - Phone:979-578-8609
Practice Address - Fax:979-578-8621
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320144183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician