Healthcare Provider Details

I. General information

NPI: 1184261844
Provider Name (Legal Business Name): TRAVIS C KLEINGARTNER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 N KINSER PIKE
BLOOMINGTON IN
47404-1914
US

IV. Provider business mailing address

1600 S OHIO ST
MARTINSVILLE IN
46151-3317
US

V. Phone/Fax

Practice location:
  • Phone: 812-335-6770
  • Fax: 812-335-6769
Mailing address:
  • Phone: 765-342-6213
  • Fax: 765-342-6851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020225A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: