Provider Demographics
NPI:1770637076
Name:TRENT, I. SHANE (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:I.
Middle Name:SHANE
Last Name:TRENT
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 OLD EMBREEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6175
Mailing Address - Country:US
Mailing Address - Phone:423-327-4702
Mailing Address - Fax:423-787-5067
Practice Address - Street 1:1420 TUSCULUM BLVD
Practice Address - Street 2:LAUGHLIN MEMORIAL HOSPITAL
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4279
Practice Address - Country:US
Practice Address - Phone:423-787-5065
Practice Address - Fax:423-787-5067
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist