Provider Demographics
NPI:1912560665
Name:MARTIN, TRENT DEOIN
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:DEOIN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TRENT
Other - Middle Name:DEOIN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2106 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-6439
Mailing Address - Country:US
Mailing Address - Phone:870-262-5149
Mailing Address - Fax:
Practice Address - Street 1:2106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6439
Practice Address - Country:US
Practice Address - Phone:870-262-5149
Practice Address - Fax:870-269-8038
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist