Healthcare Provider Details

I. General information

NPI: 1467605154
Provider Name (Legal Business Name): TRAVIS WAYNE CONDON PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 EAST 6TH ST. PHS INDIAN HEALTH CENTER
MCLAUGHLIN SD
57642-0879
US

IV. Provider business mailing address

PO BOX 879 PHS INDIAN HEALTH CENTER 701 EAST 6TH ST.
MCLAUGHLIN SD
57642-0879
US

V. Phone/Fax

Practice location:
  • Phone: 605-823-4458
  • Fax: 605-823-4470
Mailing address:
  • Phone: 605-823-4458
  • Fax: 605-823-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5203
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: