Healthcare Provider Details

I. General information

NPI: 1982206777
Provider Name (Legal Business Name): MICHAEL RAY TRENT PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-3202
US

IV. Provider business mailing address

2008 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-3202
US

V. Phone/Fax

Practice location:
  • Phone: 423-586-8013
  • Fax:
Mailing address:
  • Phone: 423-586-8013
  • Fax: 423-586-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9766
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number9766
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: