Healthcare Provider Details

I. General information

NPI: 1932021003
Provider Name (Legal Business Name): TREVOR GRACE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST
OMAHA NE
68114-4108
US

IV. Provider business mailing address

6442 S 245TH ST
ELKHORN NE
68022-3019
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-4000
  • Fax:
Mailing address:
  • Phone: 402-354-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17139
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: