Provider Demographics
NPI:1952685968
Name:HUENE, TRINA KELLY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:KELLY
Last Name:HUENE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-3931
Mailing Address - Country:US
Mailing Address - Phone:618-462-5386
Mailing Address - Fax:618-462-5852
Practice Address - Street 1:1650 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-3931
Practice Address - Country:US
Practice Address - Phone:618-462-5386
Practice Address - Fax:618-462-5852
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist