Provider Demographics
NPI:1427641034
Name:ANDERSON, TRENT GREGORY (PHARMD)
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:GREGORY
Last Name:ANDERSON
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 1:427 MAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:MENAHGA
Mailing Address - State:MN
Mailing Address - Zip Code:56464-8702
Mailing Address - Country:US
Mailing Address - Phone:218-564-4101
Mailing Address - Fax:218-564-4797
Practice Address - Street 1:427 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:MENAHGA
Practice Address - State:MN
Practice Address - Zip Code:56464-8702
Practice Address - Country:US
Practice Address - Phone:218-564-4101
Practice Address - Fax:218-564-4797
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist