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General NPI Number Information
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NPI Number | 1356623284
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Entity Type | Individual
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Provider Name | TRAVIS FLEMING PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | RR 6 BOX 840
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City | STILWELL
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State | OK
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Zip | 74960-8703
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Country | US
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Telephone | 918-696-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 1916 W PHOENIX PL
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City | BROKEN ARROW
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State | OK
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Zip | 74011-1609
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Country | US
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Telephone | 918-855-6249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14881
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License Number State | OK
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