MEDICARE: PAUL ANDREW TREVINO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	61390	TX

General Provider Information

NPI Number	:	1326672288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANDREW TREVINO PHARMD

Provider Business Mailing Address
First Line	:	17455 SPRING CYPRESS RD
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-2683
Country	:	US
Telephone Number	:	281-304-0971
Fax Number	:	281-304-0628

Provider Business Practice Location Address
First Line	:	17455 SPRING CYPRESS RD
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-2683
Country	:	US
Telephone Number	:	281-304-0971
Fax Number	:	281-304-0628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	02/28/2020

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