Provider Demographics
NPI:1588210264
Name:HUBER, TRAVIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:HUBER
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 1:1404 BLACKISTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2204
Mailing Address - Country:US
Mailing Address - Phone:812-285-0682
Mailing Address - Fax:
Practice Address - Street 1:1404 BLACKISTON MILL RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2204
Practice Address - Country:US
Practice Address - Phone:812-285-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026311A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist