Provider Demographics
NPI:1780606954
Name:TREVINO, CORANDO RIOS (PHARMACIST)
Entity type:Individual
Prefix:
First Name:CORANDO
Middle Name:RIOS
Last Name:TREVINO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:CORANDO
Other - Middle Name:RIOS
Other - Last Name:TREVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:305 W AVENUE A
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-3209
Mailing Address - Country:US
Mailing Address - Phone:361-387-4721
Mailing Address - Fax:361-387-0043
Practice Address - Street 1:305 W AVENUE A
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-3209
Practice Address - Country:US
Practice Address - Phone:361-387-4721
Practice Address - Fax:361-387-0043
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX449183500000X, 3336C0003X
TX195443336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1033380746Medicaid