Provider Demographics
NPI:1306113782
Name:TRENT, CLARENCE RONALD (RPH)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:RONALD
Last Name:TRENT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 MAIN ST
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869
Mailing Address - Country:US
Mailing Address - Phone:423-733-2203
Mailing Address - Fax:423-733-4211
Practice Address - Street 1:1267 MAIN ST
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869
Practice Address - Country:US
Practice Address - Phone:423-733-2203
Practice Address - Fax:423-733-4211
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5163OtherTENNESSEE PHARMACIST LICENSE #