Healthcare Provider Details

I. General information

NPI: 1508854100
Provider Name (Legal Business Name): GEORGIA TRAVLOS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 BRODHEAD RD SUITE B
ALIQUIPPA PA
15001-2723
US

IV. Provider business mailing address

2665 BRODHEAD RD
ALIQUIPPA PA
15001-2754
US

V. Phone/Fax

Practice location:
  • Phone: 724-375-1230
  • Fax:
Mailing address:
  • Phone: 724-375-5561
  • Fax: 724-378-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP439509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: