Provider Demographics
NPI:1467056135
Name:ROBBINS, TRAVIS BLAKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:BLAKE
Last Name:ROBBINS
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 1:416 EASTERN PLAZA CENTER
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821
Mailing Address - Country:US
Mailing Address - Phone:423-623-9533
Mailing Address - Fax:423-623-9414
Practice Address - Street 1:416 EASTERN PLAZA CENTER
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821
Practice Address - Country:US
Practice Address - Phone:423-623-9533
Practice Address - Fax:423-623-9414
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212430183500000X
TN37820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist