Provider Demographics
NPI:1801958517
Name:TRENT EAST PHARMACY
Entity type:Organization
Organization Name:TRENT EAST PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAUGHTRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:252-638-6500
Mailing Address - Street 1:937 US HIGHWAY 70 E
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-6535
Mailing Address - Country:US
Mailing Address - Phone:252-638-6500
Mailing Address - Fax:252-638-1233
Practice Address - Street 1:937 US HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-6535
Practice Address - Country:US
Practice Address - Phone:252-638-6500
Practice Address - Fax:252-638-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0255505Medicaid
NC0255505Medicaid