Provider Demographics
NPI:1376153742
Name:TRENT, DAYTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAYTON
Middle Name:
Last Name:TRENT
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 1:4000 MONTAGUE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5019
Mailing Address - Country:US
Mailing Address - Phone:806-570-9937
Mailing Address - Fax:
Practice Address - Street 1:1150 N 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3800
Practice Address - Country:US
Practice Address - Phone:217-331-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist