MEDICARE: SUSANNA TREVINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	30229643	PA

General Provider Information

NPI Number	:	1881381408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNA TREVINO

Provider Business Mailing Address
First Line	:	4530 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-1423
Country	:	US
Telephone Number	:	215-455-7330
Fax Number	:	215-455-2990

Provider Business Practice Location Address
First Line	:	4530 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-1423
Country	:	US
Telephone Number	:	215-455-7330
Fax Number	:	215-455-2990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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Directions to “ SUSANNA TREVINO ” Practice Location

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