Provider Demographics
NPI:1699846907
Name:MANNING, TRAVIS DEWAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:DEWAYNE
Last Name:MANNING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CANYON WREN DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4602
Mailing Address - Country:US
Mailing Address - Phone:214-587-3832
Mailing Address - Fax:
Practice Address - Street 1:7164 TECHNOLOGY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-2094
Practice Address - Country:US
Practice Address - Phone:214-387-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist