Healthcare Provider Details

I. General information

NPI: 1467938787
Provider Name (Legal Business Name): TREVOR JACOB MULLINS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MEDICAL PLAZA LN
WHITESBURG KY
41858-7425
US

IV. Provider business mailing address

4542 HIGHWAY 343
MC ROBERTS KY
41835-9061
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4871
  • Fax:
Mailing address:
  • Phone: 606-832-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020004
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: