Provider Demographics
NPI:1073113205
Name:KOHNHORST, TRAVIS SCOTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:SCOTT
Last Name:KOHNHORST
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 1:4601 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5705
Mailing Address - Country:US
Mailing Address - Phone:806-928-6278
Mailing Address - Fax:806-894-7599
Practice Address - Street 1:407 E HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-2629
Practice Address - Country:US
Practice Address - Phone:806-894-7583
Practice Address - Fax:806-894-7599
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist