Provider Demographics
NPI:1710200639
Name:FALLI, TRAVIS MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:MATTHEW
Last Name:FALLI
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 1:250 WASHINGTON ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-4425
Mailing Address - Country:US
Mailing Address - Phone:845-551-5582
Mailing Address - Fax:
Practice Address - Street 1:1204 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3502
Practice Address - Country:US
Practice Address - Phone:518-372-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist