Healthcare Provider Details

I. General information

NPI: 1366918989
Provider Name (Legal Business Name): TRENTON D CUNNINGHAM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 W CHEESMAN RD
ALMA MI
48801-1095
US

IV. Provider business mailing address

1356 YEOMANS ST
IONIA MI
48846-1934
US

V. Phone/Fax

Practice location:
  • Phone: 989-576-6010
  • Fax:
Mailing address:
  • Phone: 616-902-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302412888
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: