Provider Demographics
NPI:1710640727
Name:CLAYBERG, TRENTON ALEC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:ALEC
Last Name:CLAYBERG
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 1:10251 RIDGELINE DR APT G336
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-5168
Mailing Address - Country:US
Mailing Address - Phone:206-718-0272
Mailing Address - Fax:
Practice Address - Street 1:4000 W 27TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-2422
Practice Address - Country:US
Practice Address - Phone:509-582-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61186033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist