Basic Information
| Provider Information | |||||||||
| NPI: | 1912560665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | TRENT | ||||||||
| MiddleName: | DEOIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MARTIN | ||||||||
| OtherFirstName: | TRENT | ||||||||
| OtherMiddleName: | DEOIN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PHARM D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2106 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725606439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702625149 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2106 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725606439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702625149 | ||||||||
| FaxNumber: | 8702698038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2019 | ||||||||
| LastUpdateDate: | 04/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PD14750 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.