Provider Demographics
NPI:1568919371
Name:SHIPLEY, TRAVIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:TRAVIS
Other - Middle Name:
Other - Last Name:SHIPLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1168 WAGNER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7840
Mailing Address - Country:US
Mailing Address - Phone:954-931-2722
Mailing Address - Fax:
Practice Address - Street 1:1825 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5331
Practice Address - Country:US
Practice Address - Phone:704-986-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist