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General NPI Number Information
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NPI Number | 1477176535
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Entity Type | Individual
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Provider Name | TRAVIS TYLOR PATTON CPHT
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Gender | Male
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Dates
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Enumeration Date | 05/24/2020
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Last Update Date | 05/24/2020
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Provider Practice Location Address
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Address Line | 1248 KINNEYS LN
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2927
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Country | US
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Telephone | 740-356-7955
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 16TH ST
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City | WEST PORTSMOUTH
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State | OH
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Zip | 45663-5847
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Country | US
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Telephone | 606-618-1881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 09300157
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License Number State | OH
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