Provider Demographics
NPI:1366173510
Name:TREVINO, MARIO (RPH AND PHARMD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:TREVINO
Suffix:
Gender:M
Credentials:RPH AND PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 E PRICE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3193
Mailing Address - Country:US
Mailing Address - Phone:956-554-3532
Mailing Address - Fax:956-554-3549
Practice Address - Street 1:1885 E PRICE RD STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3193
Practice Address - Country:US
Practice Address - Phone:956-554-3532
Practice Address - Fax:956-554-3549
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist