MEDICARE: TRENT PERSHALL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00040593	WA

General Provider Information

NPI Number	:	1235117482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENT PERSHALL RPH

Provider Business Mailing Address
First Line	:	621 SR 9
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8525
Country	:	US
Telephone Number	:	425-334-4028
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 STATE ROUTE 9 NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8525
Country	:	US
Telephone Number	:	425-334-4028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	06/04/2008

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Directions to “ TRENT PERSHALL RPH” Practice Location

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