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General NPI Number Information
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NPI Number | 1386253623
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Entity Type | Individual
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Provider Name | TRAVIS SCOTT ROBERTSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 463855 STATE ROAD 200
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City | YULEE
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State | FL
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Zip | 32097-3639
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Country | US
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Telephone | 904-261-2405
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 ISLAND POINT DR APT 1110
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City | JACKSONVILLE
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State | FL
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Zip | 32218-5655
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Country | US
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Telephone | 954-646-4626
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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 | PS61046
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License Number State | FL
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