Provider Demographics
NPI:1013512045
Name:PENTLAND, DREW THOMAS (PHARM D)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:THOMAS
Last Name:PENTLAND
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WATERLOO COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1081
Mailing Address - Country:US
Mailing Address - Phone:618-939-3942
Mailing Address - Fax:
Practice Address - Street 1:150 WATERLOO COMMONS DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1081
Practice Address - Country:US
Practice Address - Phone:618-939-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017037466183500000X
IL051.3033391835P0018X
NDRPH6005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist