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General NPI Number Information
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NPI Number | 1700649233
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Entity Type | Individual
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Provider Name | TRAVIS SUTTER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 1898 FORT RD
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City | SHERIDAN
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State | WY
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Zip | 82801-8320
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Country | US
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Telephone | 307-675-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 572 MEIRING RD
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City | FORT RECOVERY
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State | OH
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Zip | 45846-9725
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Country | US
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Telephone |
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 03443175
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License Number State | OH
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