MEDICARE: TRAVIA POWELL

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
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1750020905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIA POWELL

Provider Business Mailing Address
First Line	:	25602 INTERSTATE 45 STE 108
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1350
Country	:	US
Telephone Number	:	832-326-0161
Fax Number	:

Provider Business Practice Location Address
First Line	:	25602 INTERSTATE 45 STE 108
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1350
Country	:	US
Telephone Number	:	832-326-0161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	06/03/2022

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Directions to “ TRAVIA POWELL ” Practice Location

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