Provider Demographics
NPI:1346722014
Name:CARLISLE, TRAVONA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVONA
Middle Name:
Last Name:CARLISLE
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 1:324 CREEKVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3909
Mailing Address - Country:US
Mailing Address - Phone:609-674-1803
Mailing Address - Fax:
Practice Address - Street 1:1168 W BRANCH ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1906
Practice Address - Country:US
Practice Address - Phone:805-474-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA72784OtherBOARD OF PHARMACY CALIFORNIA