Provider Demographics
NPI:1952896615
Name:BECKSTEAD, TREVOR R (PHARMD)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:R
Last Name:BECKSTEAD
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 1:115 N 750 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4963
Mailing Address - Country:US
Mailing Address - Phone:801-960-7682
Mailing Address - Fax:
Practice Address - Street 1:175 W CENTER ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4607
Practice Address - Country:US
Practice Address - Phone:801-224-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60836298183500000X
WAPH60856689183500000X
UT7115188-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60856689OtherPHARMACIST
UT71115188-1701OtherPHARMACIST