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General NPI Number Information
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NPI Number | 1477156107
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Entity Type | Individual
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Provider Name | TREVOR THOMAS HENDERSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 6900 N UNIVERSITY DR
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City | TAMARAC
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State | FL
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Zip | 33321-2920
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Country | US
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Telephone | 954-724-1807
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Fax |
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Provider Business Mailing Address
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Address Line | 18154 NW 21ST ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3029
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Country | US
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Telephone | 954-439-2040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PS53908
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License Number State | FL
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