Provider Demographics
NPI:1366918989
Name:CUNNINGHAM, TRENTON D (PHARMD)
Entity type:Individual
Prefix:
First Name:TRENTON
Middle Name:D
Last Name:CUNNINGHAM
Suffix:
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 1:1356 YEOMANS ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1934
Mailing Address - Country:US
Mailing Address - Phone:616-902-3160
Mailing Address - Fax:
Practice Address - Street 1:2805 W CHEESMAN RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1095
Practice Address - Country:US
Practice Address - Phone:989-576-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
MI5302412888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician