Provider Demographics
NPI:1508854100
Name:TRAVLOS, GEORGIA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:
Last Name:TRAVLOS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HALL RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1428
Mailing Address - Country:US
Mailing Address - Phone:724-728-0415
Mailing Address - Fax:
Practice Address - Street 1:2665 BRODHEAD RD
Practice Address - Street 2:SUITE B
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2723
Practice Address - Country:US
Practice Address - Phone:724-375-1230
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist