Provider Demographics
NPI:1417629833
Name:MCCLANAHAN, TRENTON LEE (RPH)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:LEE
Last Name:MCCLANAHAN
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 1:4371 KY ROUTE 680
Mailing Address - Street 2:
Mailing Address - City:GRETHEL
Mailing Address - State:KY
Mailing Address - Zip Code:41631-6327
Mailing Address - Country:US
Mailing Address - Phone:606-587-1507
Mailing Address - Fax:
Practice Address - Street 1:4371 KY ROUTE 680
Practice Address - Street 2:
Practice Address - City:GRETHEL
Practice Address - State:KY
Practice Address - Zip Code:41631-6327
Practice Address - Country:US
Practice Address - Phone:606-587-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist