Provider Demographics
NPI:1649745571
Name:MCDANIEL, TRENTON (PHARM D)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E DYKES ST
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-6514
Mailing Address - Country:US
Mailing Address - Phone:478-934-6885
Mailing Address - Fax:478-934-7312
Practice Address - Street 1:195 E DYKES ST
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-6514
Practice Address - Country:US
Practice Address - Phone:478-934-6885
Practice Address - Fax:478-934-7312
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist