Provider Demographics
NPI:1154607273
Name:TRINH, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:TRINH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 S RAINBOW BLVD STE 808
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3135
Mailing Address - Country:US
Mailing Address - Phone:702-998-9791
Mailing Address - Fax:702-998-9881
Practice Address - Street 1:4180 S RAINBOW BLVD STE 808
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3135
Practice Address - Country:US
Practice Address - Phone:702-998-9791
Practice Address - Fax:702-998-9881
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist