Provider Demographics
NPI:1477176535
Name:PATTON, TRAVIS TYLOR (CPHT)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:TYLOR
Last Name:PATTON
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-5847
Mailing Address - Country:US
Mailing Address - Phone:606-618-1881
Mailing Address - Fax:
Practice Address - Street 1:1248 KINNEYS LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2927
Practice Address - Country:US
Practice Address - Phone:740-356-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09300157183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician