Provider Demographics
NPI:1962287706
Name:JUDD, TREVOR DURRANT
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:DURRANT
Last Name:JUDD
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 1:811 S 200 E
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2102
Mailing Address - Country:US
Mailing Address - Phone:801-660-9623
Mailing Address - Fax:
Practice Address - Street 1:70 YELLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5227
Practice Address - Country:US
Practice Address - Phone:307-789-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11338036-1701183500000X
WY4484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist