Provider Demographics
NPI:1679842843
Name:TREADWELL, TRENTON VICTOR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:VICTOR
Last Name:TREADWELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 SEPIA ST
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7590
Mailing Address - Country:US
Mailing Address - Phone:321-676-8128
Mailing Address - Fax:
Practice Address - Street 1:3508 SEPIA ST
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7590
Practice Address - Country:US
Practice Address - Phone:321-676-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist