Individual
MR. GARY WAYNE TRIVANOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2405 PASS RD, BILOXI, MS 39531-2111
(228) 388-3458
(228) 388-4091
Mailing address
2405 PASS RD, BILOXI, MS 39531-2111
(228) 388-3458
(228) 388-4091
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E06129
MS
Other
Enumeration date
09/26/2011
Last updated
09/26/2011
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