Provider Demographics
NPI:1962015867
Name:PODNAR, TRENT VINCENT (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:VINCENT
Last Name:PODNAR
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 1:1606 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-4169
Mailing Address - Country:US
Mailing Address - Phone:618-942-5291
Mailing Address - Fax:618-942-5469
Practice Address - Street 1:1606 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-4169
Practice Address - Country:US
Practice Address - Phone:618-942-5291
Practice Address - Fax:618-942-5469
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist