Healthcare Provider Details

I. General information

NPI: 1356542039
Provider Name (Legal Business Name): TRAVIS EUGENE STALLBAUMER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 COMMUNITY DR
SENECA KS
66538-9739
US

IV. Provider business mailing address

1113 RIVER BLUFFS RD
SENECA KS
66538-2636
US

V. Phone/Fax

Practice location:
  • Phone: 785-336-6181
  • Fax:
Mailing address:
  • Phone: 785-548-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13515
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: