Provider Demographics
NPI:1366065880
Name:ATHERTON, TROY THOMAS (PHARMD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:THOMAS
Last Name:ATHERTON
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 1:306 MAIN ST # 103
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-1828
Mailing Address - Country:US
Mailing Address - Phone:507-895-8784
Mailing Address - Fax:507-895-4135
Practice Address - Street 1:306 MAIN ST # 103
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1828
Practice Address - Country:US
Practice Address - Phone:507-895-8784
Practice Address - Fax:507-895-4135
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist