Healthcare Provider Details

I. General information

NPI: 1467236224
Provider Name (Legal Business Name): TREVOR HOFMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6790 CASCADE RD SE
GRAND RAPIDS MI
49546-6860
US

IV. Provider business mailing address

9514 PORT SHELDON ST
ZEELAND MI
49464-9536
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-2408
  • Fax:
Mailing address:
  • Phone: 616-312-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5315244387
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: