Provider Demographics
NPI:1154370674
Name:BEACH, TRENT ALLEN SR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:ALLEN
Last Name:BEACH
Suffix:SR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MOONLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-8606
Mailing Address - Country:US
Mailing Address - Phone:302-738-7425
Mailing Address - Fax:
Practice Address - Street 1:7 MOONLIGHT CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-8606
Practice Address - Country:US
Practice Address - Phone:302-738-7425
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104301835P1200X
DEA1-00027751835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy