Healthcare Provider Details

I. General information

NPI: 1417629833
Provider Name (Legal Business Name): TRENTON LEE MCCLANAHAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 KY ROUTE 680
GRETHEL KY
41631-6327
US

IV. Provider business mailing address

4371 KY ROUTE 680
GRETHEL KY
41631-6327
US

V. Phone/Fax

Practice location:
  • Phone: 606-587-1507
  • Fax:
Mailing address:
  • Phone: 606-587-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022378
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: