Provider Demographics
NPI:1164147906
Name:KINDER, TRISTAN M
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:M
Last Name:KINDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1076
Mailing Address - Country:US
Mailing Address - Phone:419-399-5348
Mailing Address - Fax:
Practice Address - Street 1:1000 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1076
Practice Address - Country:US
Practice Address - Phone:419-399-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH060002867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist