Healthcare Provider Details

I. General information

NPI: 1194324905
Provider Name (Legal Business Name): MARY SALOME TRAVIS-KUEBLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 RILEY FUZZEL RD
SPRING TX
77386-4619
US

IV. Provider business mailing address

3731 RILEY FUZZEL RD
SPRING TX
77386-4619
US

V. Phone/Fax

Practice location:
  • Phone: 281-602-0283
  • Fax: 281-602-0285
Mailing address:
  • Phone: 281-602-0283
  • Fax: 281-602-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number35254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: