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General NPI Number Information
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NPI Number | 1659771236
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Entity Type | Individual
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Provider Name | DR. TREVOR WHITESIDE
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Gender | Male
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 503 S CHERRY GROVE AVE
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4244
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Country | US
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Telephone | 443-482-3981
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Fax |
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Provider Business Mailing Address
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Address Line | 117 HESS RD
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City | GRASONVILLE
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State | MD
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Zip | 21638-1304
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Country | US
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Telephone | 410-829-0286
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22538
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License Number State | MD
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