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General NPI Number Information
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NPI Number | 1164022547
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Entity Type | Individual
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Provider Name | TRENT RYAN WEEKS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 2415 N BLOOMINGTON ST
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City | STREATOR
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State | IL
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Zip | 61364-1305
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Country | US
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Telephone | 815-672-3517
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Fax | 815-672-3719
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Provider Business Mailing Address
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Address Line | 2245 KINGSMILL ST
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City | YORKVILLE
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State | IL
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Zip | 60560-9062
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Country | US
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Telephone | 630-362-5837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.294425
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License Number State | IL
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