Provider Demographics
NPI:1144768532
Name:MOORE, TRAVIS EUGENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:EUGENE
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 PIRATE DR # 2
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-7511
Mailing Address - Country:US
Mailing Address - Phone:606-225-9885
Mailing Address - Fax:
Practice Address - Street 1:802 11TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3409
Practice Address - Country:US
Practice Address - Phone:740-354-3259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021641183500000X
OH03443836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist