Trevor Robert Quackenbush, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

I065719 Issued in NY

Practice address

6707 Pittsford Palmyra Rd
Fairport, NY 14450-3442

Phone

(585) 360-1814

NPI assigned

Aug 23, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Fairport, NY
  • NPI 1790016509
  NPD
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1427605484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6707 PITTSFORD PALMYRA RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144503442",
            "telephone_number": "585-360-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6707 PITTSFORD PALMYRA RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144503442",
            "telephone_number": "585-360-1814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUACKENBUSH",
        "first_name": "TREVOR",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "I065719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine E Proctor, RN
• Nicholas C Prosser, D.C
• Erin Marie Provost
• Tracy Pruner
• Dakota Pursel
• Melinda Quinlan, RN
• Jaclyn R Quintero, PTA
• Mary Katherine Radford, RN
• Ralph S. Viola, MD, PLLC
• Ralph S. Viola, PLLC

• Pharmacist in Fairport, NY
• Providers in Fairport, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.