Provider Demographics
NPI:1891395737
Name:GIFFORD, IAN S (PHARMD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:S
Last Name:GIFFORD
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 1:1744 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-2367
Mailing Address - Country:US
Mailing Address - Phone:484-241-6901
Mailing Address - Fax:
Practice Address - Street 1:1875 E MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2075
Practice Address - Country:US
Practice Address - Phone:419-562-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03331546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist