Provider Demographics
NPI:1164701470
Name:TRAVIS, JODI (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 20TH ST S STE E
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4939
Mailing Address - Country:US
Mailing Address - Phone:205-212-5777
Mailing Address - Fax:205-212-5783
Practice Address - Street 1:1600 20TH ST S STE E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4939
Practice Address - Country:US
Practice Address - Phone:205-212-5777
Practice Address - Fax:205-212-5783
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL148321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist