Provider Demographics
NPI:1235117482
Name:PERSHALL, TRENT (RPH)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:PERSHALL
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 1:621 SR 9
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8525
Mailing Address - Country:US
Mailing Address - Phone:425-334-4028
Mailing Address - Fax:
Practice Address - Street 1:621 STATE ROUTE 9 NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8525
Practice Address - Country:US
Practice Address - Phone:425-334-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00040593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist