Provider Demographics
NPI:1437741055
Name:ISENBERG, TRAVIS (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:ISENBERG
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 1:3911 SHI MAR DR
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4639
Mailing Address - Country:US
Mailing Address - Phone:440-265-9312
Mailing Address - Fax:
Practice Address - Street 1:1819 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5817
Practice Address - Country:US
Practice Address - Phone:440-998-2216
Practice Address - Fax:440-992-3322
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist