Provider Demographics
NPI:1306412697
Name:TRENT, BRYAN-LEE AUSTIN
Entity Type:Individual
Prefix:
First Name:BRYAN-LEE
Middle Name:AUSTIN
Last Name:TRENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 CLUSTER DR
Mailing Address - Street 2:
Mailing Address - City:WHARNCLIFFE
Mailing Address - State:WV
Mailing Address - Zip Code:25651-7231
Mailing Address - Country:US
Mailing Address - Phone:304-664-8070
Mailing Address - Fax:
Practice Address - Street 1:28402 US HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-3924
Practice Address - Country:US
Practice Address - Phone:606-237-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYI15347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist