Provider Demographics
NPI:1932712312
Name:VAN TRESS, TRENT (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:VAN TRESS
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 1:333 E HENNEPIN AVE UNIT 1210
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-7518
Mailing Address - Country:US
Mailing Address - Phone:702-338-0188
Mailing Address - Fax:
Practice Address - Street 1:15034 SHANNON PKWY
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-1795
Practice Address - Country:US
Practice Address - Phone:651-322-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist