MEDICARE: TREVOR JORDAN MONAGHAN CPT

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	183700000X	Pharmacy Technician	571692	MI

General Provider Information

NPI Number	:	1346908449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR JORDAN MONAGHAN CPT

Provider Business Mailing Address
First Line	:	3100 E MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3850
Country	:	US
Telephone Number	:	517-782-9382
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 E MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-3850
Country	:	US
Telephone Number	:	517-782-9382
Fax Number	:

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

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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