Healthcare Provider Details

I. General information

NPI: 1275565061
Provider Name (Legal Business Name): DAVID TODD TRAYLOR R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E. AVE. A
SYRACUSE KS
67878
US

IV. Provider business mailing address

PO BOX 157 712 N. GATES ST.
SYRACUSE KS
67878-0157
US

V. Phone/Fax

Practice location:
  • Phone: 620-384-7424
  • Fax: 620-384-7424
Mailing address:
  • Phone: 620-384-5734
  • Fax: 620-384-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-11847
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: