Provider Demographics
NPI:1093375628
Name:PINKSTAFF, TRAVIS SEAN (RPH)
Entity Type:Individual
Prefix:MISS
First Name:TRAVIS
Middle Name:SEAN
Last Name:PINKSTAFF
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 1:770 ASHLAND RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-2536
Mailing Address - Country:US
Mailing Address - Phone:419-522-1409
Mailing Address - Fax:
Practice Address - Street 1:770 ASHLAND RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-2536
Practice Address - Country:US
Practice Address - Phone:419-522-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03335108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist