Provider Demographics
NPI:1245756758
Name:DUHOW, TRAVIS (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:DUHOW
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 1:680 ARBOR GLEN CIR APT 305
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2327
Mailing Address - Country:US
Mailing Address - Phone:707-771-0850
Mailing Address - Fax:
Practice Address - Street 1:5375 N SOCRUM LOOP RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4272
Practice Address - Country:US
Practice Address - Phone:863-859-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist