Provider Demographics
NPI:1508301813
Name:TRAVEL VACCINES & WELLNESS SOLUTIONS
Entity Type:Organization
Organization Name:TRAVEL VACCINES & WELLNESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-462-0188
Mailing Address - Street 1:2421 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7612
Mailing Address - Country:US
Mailing Address - Phone:480-462-0188
Mailing Address - Fax:
Practice Address - Street 1:2421 E SOUTHERN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7612
Practice Address - Country:US
Practice Address - Phone:480-462-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33212261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center