Provider Demographics
NPI:1336356443
Name:DANIELSON, TRENT LAWRENCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:LAWRENCE
Last Name:DANIELSON
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 1:3903 NYGREN PL
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-1904
Mailing Address - Country:US
Mailing Address - Phone:360-790-1980
Mailing Address - Fax:
Practice Address - Street 1:110 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3017
Practice Address - Country:US
Practice Address - Phone:360-790-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00070178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist