Provider Demographics
NPI:1891806188
Name:MERKWAN, TRENT STEVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TRENT
Middle Name:STEVEN
Last Name:MERKWAN
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 1:209 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER
Mailing Address - State:SD
Mailing Address - Zip Code:57362-1340
Mailing Address - Country:US
Mailing Address - Phone:605-853-3647
Mailing Address - Fax:605-853-3744
Practice Address - Street 1:209 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MILLER
Practice Address - State:SD
Practice Address - Zip Code:57362-1340
Practice Address - Country:US
Practice Address - Phone:605-853-3647
Practice Address - Fax:605-853-3744
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48851835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8500352Medicaid
SD1296570001Medicare ID - Type Unspecified