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General NPI Number Information
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NPI Number | 1710583505
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Entity Type | Individual
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Provider Name | TRAVIS FLETCHER PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 9175 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37923-5216
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Country | US
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Telephone | 865-776-6098
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Fax | 865-769-9420
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Provider Business Mailing Address
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Address Line | 188 YELLOWSTONE LN
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City | LENOIR CITY
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State | TN
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Zip | 37771-8274
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Country | US
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Telephone | 517-990-2166
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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 | 34218
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License Number State | TN
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