Provider Demographics
NPI:1659596757
Name:TRAVIS, SUZANNE B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:B
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7922 BERNSTEIN LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4417
Mailing Address - Country:US
Mailing Address - Phone:865-938-4302
Mailing Address - Fax:
Practice Address - Street 1:7922 BERNSTEIN LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-4417
Practice Address - Country:US
Practice Address - Phone:865-938-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist