Provider Demographics
NPI:1710583505
Name:FLETCHER, TRAVIS (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 YELLOWSTONE LN
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-8274
Mailing Address - Country:US
Mailing Address - Phone:517-990-2166
Mailing Address - Fax:
Practice Address - Street 1:9175 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5216
Practice Address - Country:US
Practice Address - Phone:865-776-6098
Practice Address - Fax:865-769-9420
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist