Healthcare Provider Details

I. General information

NPI: 1093585762
Provider Name (Legal Business Name): TRAVIS MORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 W SYLVANIA AVE
TOLEDO OH
43623-4467
US

IV. Provider business mailing address

3404 W SYLVANIA AVE
TOLEDO OH
43623-4467
US

V. Phone/Fax

Practice location:
  • Phone: 419-407-1782
  • Fax:
Mailing address:
  • Phone: 419-407-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03446728
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: