Provider Demographics
NPI:1588787386
Name:SCHNEIDER, TREVOR (RPH)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 DIX AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-3932
Mailing Address - Country:US
Mailing Address - Phone:518-743-0394
Mailing Address - Fax:518-743-0297
Practice Address - Street 1:308 DIX AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-3932
Practice Address - Country:US
Practice Address - Phone:518-743-0394
Practice Address - Fax:518-743-0297
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist