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NPI Code Detail

MEDICARE: TRAVIS L ANDERSON RPH

MEDICARE: TRAVIS L ANDERSON RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist18258MD
2183500000XPharmacist60409TX

General Provider Information

NPI Number : 1124317607
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS L ANDERSON RPH
Provider Business Mailing Address
First Line : 401 BUCKHANNON PIKE
Second Line :
City : NUTTER FORT
State : WV
Zip : 26301-4307
Country : US
Telephone Number : 304-622-6315
Fax Number : 304-622-6337
Provider Business Practice Location Address
First Line : 829 N LOOP 340 STE A
Second Line :
City : WACO
State : TX
Zip : 76705-2592
Country : US
Telephone Number : 254-202-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2011
Last Update Date : 09/08/2022

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