Provider Demographics
NPI:1043539844
Name:FLORENCE, TRENT P (RPH)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:P
Last Name:FLORENCE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8165 N 4600 W
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:UT
Mailing Address - Zip Code:84337-8502
Mailing Address - Country:US
Mailing Address - Phone:435-279-1016
Mailing Address - Fax:
Practice Address - Street 1:2400 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7233
Practice Address - Country:US
Practice Address - Phone:801-786-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369959-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT369959-1701OtherDOPL PHARMACIST
UT369959-8911OtherDOPL CONTROLLED SUBSTANCE